Background: It remains uncertain whether kidney transplant recipients are a high risk group for fracture. We conducted this study to provide a precise estimate of fracture incidence in a modern cohort of Canadian kidney transplant recipients.

Methods: We conducted a cohort study using Ontario, Canada healthcare databases to estimate the 3-year cumulative incidence of non-vertebral fracture (proximal humerus, forearm, hip) in adult kidney transplant recipients between 1994 and 2009, stratifying by sex and age (< 50 versus ≥ 50 years) at transplant. We also assessed the 10-year cumulative incidence of hip fracture alone, and non-vertebral fracture incidence in recipients compared to non-transplant reference groups matched on age, sex, and cohort entry year.

Results: We studied 4821 recipients (median age 50 years). Amongst the age and sex strata, female recipients aged ≥ 50 years had the highest 3-year cumulative incidence of non-vertebral fracture (3.1%, 95% CI 2.1-4.4%). Recipients had a higher 3-year cumulative incidence of non-vertebral fracture (1.6%, 95% CI 1.3-2.0%) compared to the general population with no previous non-vertebral fracture (0.5%, 95% CI 0.4-0.6%; P<0.0001) and non-dialysis chronic kidney disease (1.1%, 95% CI 0.9-1.2%; P=0.03), but a lower fracture incidence than the general population with a previous non-vertebral fracture (2.3%, 95% CI 1.9-2.8%; P=0.007). The 10-year cumulative incidence of hip fracture in all recipients was 1.7% (≥3% defined as high risk).

Conclusions: Our results suggest that despite the changes in mineral metabolism and use of steroids after kidney transplantation most recipients will not experience a fracture in follow-up. This has implications for the need and conduct of future clinical trials and preventative fracture strategies after transplant.

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