Optimising bone health among older people with hip fractures and co-existing advanced chronic kidney disease.

Patients with a hip fracture and co-existing advanced chronic kidney disease (CKD) are at risk of further fractures due to either CKD-mineral bone disease or osteoporosis. An analysis of a hospital's hip fracture service registry of patients ≥ 60 years with CKD stage 4 (15-29 ml/min/1.73m 46 patients were included in the analysis. The prevalence of CKD stage 4 and 5 was 3%. The mean age was 84 years, half had ≥ 2 comorbid conditions and 76% had a Nottingham Hip Fracture Score of ≥ 5. 54% and 80% died at 12 months and 2 years. None were on any osteoporosis treatment on discharge. 85% were prescribed either calcium-vitamin D or vitamin D supplementation. 30% had a bone health clinic appointment made, but less than half attended. Patients with advanced CKD admitted to hospital with a hip fracture have a poor survival. In many, the focus of care should be on supporting quality daily living and not bone health optimisation.