# Femoral artery calcification predicts hip fracture in maintenance hemodialysis patients

## TL;DR

Femoral artery calcification is a strong predictor of hip fractures in hemodialysis patients and is linked to worse survival outcomes.

## Contribution

This study identifies femoral artery calcification as an independent risk factor for hip fractures in hemodialysis patients.

## Key findings

- Higher femoral artery calcification scores are associated with increased hip fracture risk in hemodialysis patients.
- Femoral artery calcification remains a significant predictor of hip fractures even after adjusting for traditional risk factors.
- Patients with higher femoral artery calcification scores and hip fractures have worse survival outcomes.

## Abstract

Femoral artery calcification (FAC) is a significant predictor of hip fractures in hemodialysis patients. A higher FAC score is associated with increased fracture risk and poor survival outcomes. Identifying FAC through radiographic assessment may improve fracture risk stratification and clinical management in this high-risk population.

Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at increased risk for vascular calcification (VC) and bone fractures. While previous studies have linked aortic calcification with hip fractures, the relationship between medium-caliber artery-femoral artery calcification (FAC) and fall-related hip fractures in HD patients remains unclear.

We retrospectively analyzed 170 HD patients who experienced falls and sought treatment in the emergency department (ED) between 2007 and 2014. The FAC score, representing the severity of femoral artery calcification, was calculated as the ratio of the total length of calcification plaques to the length of the femoral vessel visible on plain radiographs of the hip and femur. A logistic regression model assessed the association between FAC score and hip fracture risk, and receiver operating characteristic curve analysis evaluated its predictive power.

Among the 130 patients meeting inclusion criteria, 55 had fall-related hip fractures. The incidence rate of hip fractures among dialysis patients was 6.18 cases per 1000 person-years by dividing the total number of hip fracture events by the cumulative dialysis duration (in years) of all enrolled patients. Fracture patients were older and had lower serum creatinine, sodium, and albumin levels but higher aspartate aminotransferase levels. The fracture group also had a higher FAC score (0.47 [IQR, 0.28 – 0.76] vs. 0.00 [IQR, 0.00 – 0.40], p < 0.001). Multivariable analysis identified old age, heart failure with reduced ejection fraction (EF), and higher FAC scores as independent risk factors for hip fractures. Survival curves showed increased mortality among patients with higher FAC scores and hip fractures (p < 0.01). Conclusion.

High FAC scores were associated with an increased risk of hip fractures in HD patients, independent of traditional risk factors, and were linked to poor survival outcomes.

The online version contains supplementary material available at 10.1007/s11657-025-01536-1.