Patient selection: hemodialysis patient
Outcomes:
(1) new hip fracture
(2) any new fracture
Types of risk factors:
(1) increased risk of falls
(2) increased risk of osteoporosis
(3) increased risk of osteomalacia
Risk factors:
(1) older age (age >= 55, with further increase if >= 75)
(2) female gender
(3) history of renal transplant
(4) low serum albumin
(5) high parathyroid hormone level (> 900 pg/mL, secondary hyperparathyroidism)
(6) narcotic medications
(7) benzodiazepines
(8) selective serotonin reuptake inhibitors (SSRI)
(9) corticosteroids
(10) history of previous fracture
Interpretation:
• The more risk factors that are present, the greater the risk for a fracture after a fall.
• Some risk factors are modifiable, primarily medications and control of hyperparathyroidism.
• Some patients may benefit from drugs to reverse osteoporosis.
