# Hip Fracture Pathology in Chronic Kidney Disease

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN DIEGO · 2024 · $627,954

## Abstract

PROJECT SUMMARY
 Hip fractures are common, costly, and strongly associated with morbidity and mortality. For patients with
chronic kidney disease (CKD), fracture risk and post-fracture mortality are double what they are in the general
population; and dialysis patients sustain hip fractures 10-15 years younger than their age-matched
counterparts.
 Treatment for hip fracture in CKD is particularly challenging because these patients have multiple different
pathologies of bone disease, and the distinct pathologies have different treatments. Patients with CKD can
have age-related osteoporosis similar to non-CKD patients, but may also have CKD-related metabolic bone
disease reflecting low turnover disease, high turnover disease (typically driven by hyperparathyroidism) or
mixed lesions, even at the same level of bone mineral density. Low bone turnover in CKD patients appears to
be increasing in frequency, and is problematic as most standard anti-fracture medications may exacerbate low
turnover bone disease. On the other hand, there are now several FDA approved treatments that stimulate,
rather than suppress, bone turnover. Thus, it is particularly timely to understand bone turnover in CKD patients,
and ultimately see if this information can guide clinicians to improve patient outcomes.
 Bone biopsy and histomorphometry are the gold standard for determining bone turnover. These methods
are not widely available and are rarely obtained due to only a few specialized centers performing them. When
available, however, bone histomorphometry is typically evaluated at the iliac crest, which is poorly correlated
with bone turnover at other bone sites including the hip. In order to better understand bone turnover at the hip,
we propose histomorphometry using hip bone tissue taken during surgical repair of hip fracture in CKD patients
as it may deliver relevant information about bone metabolism and structure. Specifically, we will determine the
prevalence and risk factors for low bone turnover in hip fracture patients with CKD (Aim 1).
 Without biopsy, clinicians are limited in their ability to identify a subset of patients with low bone turnover.
Our preliminary data suggest biomarkers hold promise to identify low bone turnover with high specificity in
CKD patients. Yet, the optimal biomarker panel to define low bone turnover at the hip does not currently exist.
We propose to develop a panel using serum biomarkers based on findings from hip bone biopsy and
histomorphometry indicative of low bone turnover (Aim 2). Our recent findings suggest that using serum
biomarkers that are specific for low bone turnover based on iliac crest histomorphometry can be applied to
community-living individuals with CKD and provide important information on future fracture risk. Thus, we will
apply these biomarkers based on bone turnover at the hip to a cohort of women with CKD who are well-
characterized for bone mineral density and fractures (in the Study of Osteoporotic Fractures) t...

## Key facts

- **NIH application ID:** 10768615
- **Project number:** 5R01AG065876-05
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN DIEGO
- **Principal Investigator:** Jan Marie Hughes-Austin
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $627,954
- **Award type:** 5
- **Project period:** 2020-03-01 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10768615

## Citation

> US National Institutes of Health, RePORTER application 10768615, Hip Fracture Pathology in Chronic Kidney Disease (5R01AG065876-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10768615. Licensed CC0.

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