(SLA-010) Erythropoiesis-stimulating agent and risk of osteoporotic fracture among chronic kidney disease patients: A territory-wide nested case-control study

Background: It is unclear whether erythropoietin use is associated with osteoporotic fracture in humans.

Objectives: We aimed to evaluate the relationship between erythropoiesis-stimulating agent (ESA) use and osteoporotic fractures.

Methods: Using the electronic health record from the Hong Kong Hospital Authority, we conducted a territory-wide nested case-control study among patients with chronic kidney disease (CKD) using ESA between 2005 and 2022. Incidence cases of osteoporotic fracture were matched with up to 10 fracture-free controls on age, sex, and year of fracture incidence. We estimated the adjusted odd ratio (aOR) and 95% confidence interval (CI) for the association of ESA and fracture risk using conditional logistic regression, adjusted for imbalanced CKD-related risk factors after matching.

Results: 959 osteoporotic fracture cases were identified and matched with 9262 fracture-free control. The duration of ESA treatment was associated with an increased risk of fracture (aOR per year of ESA treatment 1.27, 95% CI 1.21 to 1.33), while accumulated ESA dose was not. In addition, the increased risk of fracture was observed in ESA responders when compared to ESA non-responders (aOR 1.52, 95% CI 1.30 to 1.78). Similar results were observed in sensitivity analysis with stratified treatment years and adjustment with anaemia severity.

Conclusions: This study suggests that longer duration use of ESA and ESA responders may be associated with an increased risk of fractures among patients with CKD. These findings may facilitate development of the optimal management regimen for CKD-related anemia.