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Postmenopausal women with chronic kidney disease, as indicated by serum cystatin-C levels, are at substantially increased risk of sustaining a hip fracture.

In the August issue of the Journal of the American Geriatric Society, Dr. Andrea Z. LaCroix of the Fred Hutchinson Cancer Research Center, Seattle, Washington and colleagues note that severe kidney disease is associated with hip fracture risk. Chronic kidney disease is common but frequently unrecognized clinically when it is mild or moderate.

To examine the utility of serum cystatin-C as a biomarker of renal function and hence fracture risk, the researchers studied data on 376 women with incident hip fractures and 376 matched controls. All were participants in a large cohort study of women aged 50 to 79 years who were followed for an average of seven years.

"The unadjusted odds ratio for incident hip fracture comparing the highest and lowest quartiles of cystatin-C levels was 1.51," the researchers report. After adjustment for body mass index (BMI), the odds ratio increased to 2.14.

When cystatin-C levels were used to estimate glomerular filtration rates, the team found that participants with a value of less than 60 L/min per 1.73 m² had an odds ratio for hip fracture of 2.50.

The investigators conclude that postmenopausal women with chronic kidney disease Stage 3 or higher should be considered at high risk for hip fracture and evaluated for bone disease.

J Am Geriatr Soc 2008;56:1434-1441