Increased risk of bone fracture among patients with urinary calculi: a nationwide longitudinal population-based study

• Published in: Osteoporosis international Vol. 26; no. 4; pp. 1261 - 1269
• Main Authors: Ou, S.-M., Chen, Y.-T., Shih, C.-J., Tarng, D.-C.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.04.2015; Springer Nature B.V
• Subjects: Adult; Aged; Bone density; Calcium; Comorbidity; Endocrinology; Female; Fractures; Humans; Incidence; Kidney stones; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - etiology; Propensity Score; Rheumatology; Risk Assessment; Risk factors; Taiwan - epidemiology; Urinary Calculi - complications; Urinary Calculi - epidemiology; Taiwan; Propensity score matching; Urinary calculi; Bone mineral density; Fracture; Calcium
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-014-2998-5

Summary Urinary calculi were associated with higher risk of vertebral and upper limb fracture. Therefore, patients with urinary calculi should be evaluated carefully because they may have a higher risk of subsequent fracture later in life. Introduction The contribution of urinary calculi to reduced bone mineral density has been recognized. However, the association of urinary calculi with the risk of fracture remains inconclusive. The aim of the study was to determine the risk of overall fracture and fractures at different anatomic sites in patients with urinary calculi. Methods The records of inpatients and outpatients with urinary calculi were retrieved from the Taiwan National Health Insurance Database from 2000 to 2010. Among patients with urinary calculi at the cohort entry, controls were matched using propensity scores on a 1:1 ratio. All subjects were followed up from the date of enrollment until fracture occurrence, death, or December 31, 2010. There were 46,243 Medicare beneficiaries with a diagnosis of urinary calculi and 46,243 controls without calculi enrolled. Results Among these patients, 6005 patients with a diagnosis of urinary calculi and 5339 controls developed fractures during a median follow-up period of 5.3 years. Patients with urinary calculi had a higher incidence of fracture compared with controls (23.9 versus 22.1 per 1000 person-years) and a greater risk of overall fractures (adjusted hazard ratio [aHR] 1.08, 95 % confidence interval [CI], 1.04–1.12), mainly located at the vertebrae (aHR 1.15, 95 % CI, 1.06–1.25) and upper limb (aHR 1.07, 95 % CI, 1.01–1.14), but the risk for hip fracture was not increased (aHR 1.09, 95 % CI, 0.96–1.22). Conclusions Urinary calculus is independently associated with higher risk of subsequent fracture. Patients with urinary calculi should pay attention to the future vertebral and upper limb fractures.