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Few data exist on the association between cardiovascular health and incident fracture risk in patients with advanced CKD, a high-risk population for fractures. We aimed to assess the link between fracture risk and cardiovascular health in a prospective cohort of 210 patients with CKD stage G4\u20135. Incident fractures were recorded during a prospective follow-up of 5\u00a0years. Laboratory parameters, abdominal aortic calcification score, echocardiography, ultrasound assessment of brachial artery flow-mediated dilatation and carotid intima-media thickness, and maximal stress ergometry were obtained at baseline. A total of 51 fractures were observed in 40 (19%) patients during follow-up. In separate multivariable Cox proportional hazards models adjusted for age, gender, and baseline eGFR, TnT (HR 1.007, CI 95% 1.003\u20131.010, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and ProBNP (HR 1.000, CI 95% 1.000\u20131.000, <jats:italic>p<\/jats:italic>\u2009=\u20090.017) were associated with incident fractures and the association persisted after adjusting for coronary artery disease (CAD). The patients unable to perform the ergometry test had a higher risk of incident fractures compared to others (36.1% vs 15.5%, <jats:italic>p<\/jats:italic>\u2009=\u20090.009). A cardiovascular composite risk score summarizing TnT, ProBNP, and ergometry data was independently associated with incident fractures in a multivariable Cox model (HR 1.373, CI 95% 1.180\u20131.599, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Patients with the lowest score were observed with no fractures, while patients with the highest score were observed with a fracture risk of 40.5% during follow-up. Risk of incident fractures is associated with biomarkers of cardiovascular health and a composite cardiovascular risk score in patients with advanced CKD.<\/jats:p>","DOI":"10.1007\/s00223-024-01275-4","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T06:32:36Z","timestamp":1724308356000},"page":"516-524","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cardiac Biomarkers are Associated with Incident Fracture Risk in Advanced Chronic Kidney Disease"],"prefix":"10.1007","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6537-9056","authenticated-orcid":false,"given":"Louise","family":"Aaltonen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapio","family":"Hellman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roosa","family":"Lankinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Hakam\u00e4ki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaj","family":"Mets\u00e4rinne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"J\u00e4rvisalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"issue":"15","key":"1275_CR1","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.1001\/jama.2009.1463","volume":"302","author":"U Sennerby","year":"2009","unstructured":"Sennerby U (2009) Cardiovascular diseases and risk of hip fracture. 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Louise Aaltonen, Tapio Hellman, Roosa Lankinen, Markus Hakam\u00e4ki, Kaj Mets\u00e4rinne, and Mikko J\u00e4rvisalo declare no\u00a0competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}},{"value":"This study was conducted in accordance with the declaration of Helsinki and approved by the Ethics committee of the Hospital District of Southwest Finland. The study is registered in\u00a0ClinicalTrials.gov\u00a0(ID is\u00a0NCT04223726).\u00a0No animal studies were performed in the course of these experiments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All subjects gave written informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}