Erythropoietin treatment and osteoporotic fracture risk in hemodialysis patients: A nationwide population-based study
10.1016/j.afos.2024.11.002
- Author:
Ching-Yu LEE
1
;
Fung-Chang SUNG
;
Peir-Haur HUNG
;
Chih-Hsin MUO
;
Meng-Huang WU
;
Tsung-Jen HUANG
;
Chih-Ching YEH
Author Information
1. Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- Publication Type:Original article
- From:Osteoporosis and Sarcopenia
2024;10(4):157-164
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objectives:Concerns about erythropoietin (EPO) therapy for anemia in patients with end-stage renal disease (ESRD) contributing to potential bone loss and increased fracture risks are growing. This study investigated the impact of EPO administration on the risk of common osteoporotic fractures in ESRD patients.
Methods:This population-based retrospective cohort study compared EPO users and non-EPO users among ESRD patients undergoing hemodialysis, diagnosed with ESRD between 2000 and 2014 identified from the National Health Insurance Research Database of Taiwan. The cohorts were matched at a propensity score ratio of 1:1, resulting in equal sample sizes of 2839. Variables related to comorbidities were considered.
Results:EPO users exhibited higher cumulative incidences of major osteoporotic fractures, hip fractures, spine fractures, and wrist fractures compared with the non-EPO user (all P < 0.001). In adjusted Cox regression models, higher adjusted subdistribution hazard ratios (aSHRs) were observed for major osteoporotic fractures (2.41, 95% confidence interval [CI] = 2.01–2.89), osteoporotic hip fractures (2.19, 95% CI = 1.69–2.85), spine fractures (2.50, 95% CI = 1.87–3.34), and wrist fractures (2.34, 95% CI = 1.44–3.78) in EPO users than in nonEPO users. The risk of major osteoporotic fractures significantly increased with increasing EPO doses (P for trend < 0.0001), and a similar trend was observed for the risks of osteoporotic spine and wrist fractures.
Conclusions:Our findings suggest that EPO treatment in patients with ESRD undergoing hemodialysis is associated with an increased risk of osteoporotic fractures.
