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

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Abstract

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.

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Acknowledgments

This study was supported to Dr. D.C. Tarng by grants from the National Science Council, Taipei Veterans General Hospital, Foundation for Poison Control, and Ministry of Education’s aim for the Top University Plan. This study was based in part on data from the NHIRD provided by the Bureau of NHI, Department of Health and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of Bureau of NHI, Department of Health, and National Health Research Institutes.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. School of Medicine, National Yang-Ming University, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan

    S.-M. Ou, Y.-T. Chen, C.-J. Shih & D.-C. Tarng

  2. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    S.-M. Ou & D.-C. Tarng

  3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    S.-M. Ou & D.-C. Tarng

  4. Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan

    Y.-T. Chen

  5. Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan

    C.-J. Shih

  6. Institutes of Physiology and Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    D.-C. Tarng

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  1. S.-M. Ou
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  2. Y.-T. Chen
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Corresponding author

Correspondence to D.-C. Tarng.

Additional information

Shuo-Ming Ou and Yung-Tai Chen contributed equally to this study.

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Ou, SM., Chen, YT., Shih, CJ. et al. Increased risk of bone fracture among patients with urinary calculi: a nationwide longitudinal population-based study. Osteoporos Int 26, 1261–1269 (2015). https://doi.org/10.1007/s00198-014-2998-5

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  • DOI: https://doi.org/10.1007/s00198-014-2998-5

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