*Purpose: Living kidney donors were shown to have derangements of bone biomarkers resembling those occurring in early chronic kidney disease within 36 months of donation. The clinical significance of these findings is unknown. The objective of this study was to examine the risk of fractures in prior living kidney donors.

*Methods: We conducted a survey of previous kidney donors at three transplant centers who were more than 10 years post donation and were > 50 years of age. We compared the observed number of patients who self-reported fractures with expected numbers using standardized incidence ratios (SIR). Expected numbers were derived by applying local calendar year-, age- and sex-specific fracture rates to the calendar year-, age- and sex-specific person-years of follow-up in the kidney donor cohort.

*Results: Of the 930 surveys that were returned, 891 (95.8%) provided signed consent, and were included in the analysis. The mean age of the respondents was 65.0 (± 8.9, Range 48 – 93), 56% were female, mean time from donation was 20.2 years (± 8.9, Range 10.1 – 56.4). 145 (16.3%) donors reported at least one bone fracture and 36 (4.0%) reported more than one fracture. We observed a total of 145 respondents with fractures whereas the expected number of individuals with at least one fracture was 306.5 corresponding to a SIR of 0.47 (95% CI 0.4-0.56). Table 1 shows sex and site-specific fracture data.

*Conclusions: Older prior living kidney donors who responded to a survey have an overall lower risk of fractures compared to the general population. Comparison to a comparable healthy control population is necessary for validation of these findings.

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