Epidemiology of Fracture in Adults from Ontario, Canada, with Chronic Kidney Disease: An Examination of Fracture Burden Using Administrative Health Data
Bibliographic record
Abstract
Fractures are associated with morbidity and mortality.Individuals with chronic kidney disease (CKD) experience bone mineral metabolism changes, which increases fracture risk.Researchers have quantified the epidemiology of fractures in adults with CKD using administrative health databases from Ontario, Canada, held at the Institute for Clinical Evaluative Sciences.Results demonstrated that many individuals with non-transplant CKD sustain fractures, with the risk increasing as kidney function declines.However, fracture risk in kidney transplant recipients was lower than previously described, which suggests recipients may not be a high-risk fracture group.There is a need to test fracture prevention interventions in the CKD population. The IssueThe number of chronic kidney disease (CKD) patients in Canada is increasing, with over three million adults living with CKD (Arora et al. 2013; CIHI 2013).There is a concern about poor outcomes associated with CKD, one of which is fractures.Several studies assessing the epidemiology of fracture in CKD have been conducted using administrative databases in the United States.However, these findings may not accurately reflect the Canadian experience, as fracture rates have been shown to vary as much as 15-fold across countries (Kanis et al. 2002).Access to large healthcare databases in Ontario, Canada, provides an opportunity to conduct a comprehensive examination of the epidemiology of fracture in the CKD population.Multiple factors likely contribute to an increased fracture risk in the CKD population.As kidney function declines, CKD-related mineral and bone disorders may develop (i.e., changes in calcium, phosphorous, vitamin D or parathyroid hormone metabolism), and this can lead to an increased fracture risk (Kidney Disease Improving Global Outcomes [KDIGO] 2009).Other factors may also increase fracture risk, such as muscle wasting (West et al. 2012) and steroid administration to kidney transplant recipients (Canalis et al. 2007).Despite this increased fracture risk, there remain many unanswered questions about interventions that will safely prevent fractures in the CKD population (KDIGO 2009;Palmer et al. 2009).Moreover, many of the guideline statements for the treatment and evaluation of bone disease in CKD patients are weak or ungraded (KDIGO 2009).An improved understanding of the epidemiology of fracture in the CKD population informs the conduct of well-designed clinical trials and prospective studies.This report highlights several recent studies conducted at the Institute for Clinical Evaluative Sciences (ICES) by the provincial Kidney, Dialysis and Transplantation team aimed to clarify fracture incidence, improve clinical guidelines, advance prognostication and guide informed consent to help decrease the fracture burden in the CKD population. Key Findings Fracture incidence in the non-transplant chronic kidney disease population
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.011 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".