Osteoporos Sarcopenia.
2024 Dec;10(4):157-164. 10.1016/j.afos.2024.11.002.
Erythropoietin treatment and osteoporotic fracture risk in hemodialysis patients: A nationwide population-based study
- Affiliations
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- 1Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- 2Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- 3Orthopedics Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- 4Department of Health Services Administration, China Medical University, Taichung, Taiwan
- 5Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- 6Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
- 7Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- 8Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
- 9Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- 10School of Public Health, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- 11Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- 12Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- 13Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- KMID: 2563763
- DOI: http://doi.org/10.1016/j.afos.2024.11.002
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.
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