{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:40:40Z","timestamp":1793050840478,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002973","name":"Daiichi Sankyo Co., Ltd.","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002973","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Exp Nephrol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with chronic kidney disease who have progressed to dialysis treatment have increased fracture risk. However, the impact of osteoporosis treatment on fracture risk has not been evaluated in a large-scale study using Japanese real-world data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective observational study (UMIN000054749), DeSC-IQVIA Integrated Claims Data were used to investigate the impact of osteoporosis treatment on fracture risk and other events in patients receiving maintenance hemo- or peritoneal dialysis. Data from April 2014 to August 2022 were extracted, and patients were divided into treated\/untreated groups based on prescription records for osteoporosis medications during a 1-year exposure assessment period. The primary endpoint was the incidence of total and hip fractures from the index date (1\u00a0year post-exposure assessment period) until the end of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 156,557 patients receiving maintenance dialysis for\u2009\u2265\u20091\u00a0year, 38,246 were included: 1093 and 37,153 in the treated and untreated groups, respectively. Although there was a numerically higher fracture incidence in the treated group, no significant difference was observed between the groups overall. As aged, the difference in fracture risk between the groups decreased. Multivariable regression analysis revealed that age, sex, fracture history (primary risk factor), diabetes, and sleep disorder were statistically significant effect modifiers of fracture risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The numerically higher incidence of fractures in the treated group may have been due to patient background differences. Fracture risk management is essential in dialysis patients, and osteoporosis treatment should be considered at an earlier age, taking into account the patient\u2019s background.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10157-026-02858-1","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T15:50:13Z","timestamp":1777132213000},"page":"1125-1137","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of osteoporosis treatment with risk of fracture, cardiovascular disease, and all-cause mortality in patients on maintenance dialysis: a retrospective database study using real-world data in Japan"],"prefix":"10.1007","volume":"30","author":[{"given":"Yasuo","family":"Imanishi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanae","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisako","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Kawai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Eguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kengo","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Sadachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Shintani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"issue":"6","key":"2858_CR1","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1007\/s10157-009-0199-x","volume":"13","author":"E Imai","year":"2009","unstructured":"Imai E, Horio M, Watanabe T, et al. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol. 2009;13(6):621\u201330.","journal-title":"Clin Exp Nephrol"},{"key":"2858_CR2","unstructured":"2022 Japanese Society for Dialysis Therapy Statistical Survey Report (in Japanese). https:\/\/docs.jsdt.or.jp\/overview\/file\/2022\/pdf\/01.pdf. Accessed 1 April 2026."},{"key":"2858_CR3","doi-asserted-by":"crossref","unstructured":"KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Chapter 1: Introduction and definition of CKD\u2013MBD and the development of the guideline statements. Kidney Int Suppl. 2009; 76(Supplement 113):S3\u20138.","DOI":"10.1038\/ki.2009.189"},{"issue":"1","key":"2858_CR4","doi-asserted-by":"publisher","first-page":"167","DOI":"10.3390\/nu15010167","volume":"15","author":"E Bellorin-Font","year":"2022","unstructured":"Bellorin-Font E, Rojas E, Martin KJ. Bone disease in chronic kidney disease and kidney transplant. Nutrients. 2022;15(1):167.","journal-title":"Nutrients"},{"issue":"1","key":"2858_CR5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s42358-020-0118-0","volume":"60","author":"M Slouma","year":"2020","unstructured":"Slouma M, Sahli H, Bahlous A, et al. Mineral bone disorder and osteoporosis in hemodialysis patients. Adv Rheumatol. 2020;60(1):15.","journal-title":"Adv Rheumatol"},{"issue":"6","key":"2858_CR6","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1038\/ki.2008.264","volume":"74","author":"TL Nickolas","year":"2008","unstructured":"Nickolas TL, Leonard MB, Shane E. Chronic kidney disease and bone fracture: a growing concern. Kidney Int. 2008;74(6):721\u201331.","journal-title":"Kidney Int"},{"issue":"37","key":"2858_CR7","doi-asserted-by":"publisher","first-page":"e7618","DOI":"10.1097\/MD.0000000000007618","volume":"96","author":"LW Hung","year":"2017","unstructured":"Hung LW, Hwang YT, Huang GS, Liang CC, Lin J. The influence of renal dialysis and hip fracture sites on the 10-year mortality of elderly hip fracture patients: a nationwide population-based observational study. Medicine. 2017;96(37):e7618.","journal-title":"Medicine"},{"key":"2858_CR8","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.bone.2014.04.017","volume":"64","author":"ZZ Lin","year":"2014","unstructured":"Lin ZZ, Wang JJ, Chung CR, et al. Epidemiology and mortality of hip fracture among patients on dialysis: Taiwan national cohort study. Bone. 2014;64:235\u20139.","journal-title":"Bone"},{"issue":"10","key":"2858_CR9","doi-asserted-by":"publisher","first-page":"2891","DOI":"10.1007\/s00198-016-3648-x","volume":"27","author":"UA Al-Sari","year":"2016","unstructured":"Al-Sari UA, Tobias J, Clark E. Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int. 2016;27(10):2891\u2013900.","journal-title":"Osteoporos Int"},{"issue":"7","key":"2858_CR10","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1007\/s001980070075","volume":"11","author":"JA Cauley","year":"2000","unstructured":"Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporos Int. 2000;11(7):556\u201361.","journal-title":"Osteoporos Int"},{"issue":"5","key":"2858_CR11","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1001\/jama.2009.50","volume":"301","author":"D Bliuc","year":"2009","unstructured":"Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513\u201321.","journal-title":"JAMA"},{"issue":"1","key":"2858_CR12","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1093\/ndt\/gfaa192","volume":"36","author":"P Evenepoel","year":"2021","unstructured":"Evenepoel P, Cunningham J, Ferrari S, et al. European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4\u2013G5D. Nephrol Dial Transplant. 2021;36(1):42\u201359.","journal-title":"Nephrol Dial Transplant"},{"issue":"11","key":"2858_CR13","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1038\/sj.ki.5000414","volume":"69","author":"S Moe","year":"2006","unstructured":"Moe S, Dr\u00fceke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006;69(11):1945\u201353.","journal-title":"Kidney Int"},{"key":"2858_CR14","doi-asserted-by":"publisher","first-page":"e18063","DOI":"10.7717\/peerj.18063","volume":"12","author":"X Liang","year":"2024","unstructured":"Liang X, Li Y, Wang P, Liu H. Key regulators of vascular calcification in chronic kidney disease: hyperphosphatemia, BMP2, and RUNX2. PeerJ. 2024;12:e18063.","journal-title":"PeerJ"},{"issue":"6","key":"2858_CR15","doi-asserted-by":"publisher","first-page":"181","DOI":"10.31083\/j.rcm2406181","volume":"24","author":"D Hirsch","year":"2023","unstructured":"Hirsch D, Lau B, Kushwaha V, Yong K. The controversies of coronary artery disease in end-stage kidney disease patients: a narrative review. Rev Cardiovasc Med. 2023;24(6):181.","journal-title":"Rev Cardiovasc Med"},{"key":"2858_CR16","unstructured":"DeSC-IQVIA Integrated Claims Data. https:\/\/www.iqvia.com\/library\/fact-sheets\/get-rich-insights-with-the-japanese-claims-plus2-dataset. Accessed 1 April 2026."},{"issue":"4","key":"2858_CR17","doi-asserted-by":"publisher","first-page":"328","DOI":"10.3390\/nu9040328","volume":"9","author":"G Jean","year":"2017","unstructured":"Jean G, Souberbielle JC, Chazot C. Vitamin D in chronic kidney disease and dialysis patients. Nutrients. 2017;9(4):328.","journal-title":"Nutrients"},{"key":"2858_CR18","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","volume":"94","author":"JP Fine","year":"1999","unstructured":"Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496\u2013509.","journal-title":"J Am Stat Assoc"},{"key":"2858_CR19","doi-asserted-by":"publisher","first-page":"115242","DOI":"10.1016\/j.bone.2020.115242","volume":"133","author":"K Iseri","year":"2020","unstructured":"Iseri K, Carrero JJ, Evans M, et al. Major fractures after initiation of dialysis: incidence, predictors and association with mortality. Bone. 2020;133:115242.","journal-title":"Bone"},{"issue":"12","key":"2858_CR20","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s12603-023-2045-3","volume":"27","author":"SH Fu","year":"2023","unstructured":"Fu SH, Lai CY, Wang CY, et al. Screening of fracture risk and osteoporosis among older long-term care residents: a prospective study. J Nutr Health Aging. 2023;27(12):1255\u201361.","journal-title":"J Nutr Health Aging"},{"issue":"10","key":"2858_CR21","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.3390\/medicina57101119","volume":"57","author":"F Migliorini","year":"2021","unstructured":"Migliorini F, Giorgino R, Hildebrand F, et al. Fragility fractures: risk factors and management in the elderly. Medicina (Kaunas). 2021;57(10):1119.","journal-title":"Medicina (Kaunas)"},{"issue":"2","key":"2858_CR22","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1007\/s10157-024-02562-y","volume":"29","author":"Y Imanishi","year":"2025","unstructured":"Imanishi Y, Taniuchi S, Kodama S, et al. Real-world fracture risk, osteoporosis treatment status, and mortality of Japanese non-dialysis patients with chronic kidney disease stages G3\u20135. Clin Exp Nephrol. 2025;29(2):236\u201347.","journal-title":"Clin Exp Nephrol"},{"key":"2858_CR23","unstructured":"Japan Osteoporosis Society, The Japanese Society for Bone and Mineral Research, Japan Osteoporosis Foundation (eds). Japanese 2025 guidelines for prevention and treatment of osteoporosis. Tokyo: Life Science Publishing; 2025 (in Japanese)."},{"issue":"1","key":"2858_CR24","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.kint.2015.11.004","volume":"89","author":"SM Ott","year":"2016","unstructured":"Ott SM. Bone strength: more than just bone density. Kidney Int. 2016;89(1):16\u20139.","journal-title":"Kidney Int"}],"container-title":["Clinical and Experimental Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10157-026-02858-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10157-026-02858-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10157-026-02858-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T05:40:23Z","timestamp":1782193223000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10157-026-02858-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":24,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["2858"],"URL":"https:\/\/doi.org\/10.1007\/s10157-026-02858-1","relation":{},"ISSN":["1342-1751","1437-7799"],"issn-type":[{"value":"1342-1751","type":"print"},{"value":"1437-7799","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,25]]},"assertion":[{"value":"25 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Yasuo Imanishi: Honoraria (Daiichi Sankyo Co., Ltd., Teijin Healthcare Ltd., Kyowa Kirin Co., Ltd., and Asahi Kasei Pharma Corporation). Kanae Takahashi: No conflicts of interest to declare. Hisako Yoshida: Consultancies (Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., and Kyowa Kirin Co., Ltd.); and Grants (Daiichi Sankyo Co., Ltd. and Organization for Clinical Medicine Promotion). Ryota Kawai: Consultancies (Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., and Kyowa Kirin Co., Ltd.); and Grants (Daiichi Sankyo Co., Ltd.). Yuki Eguchi, Kengo Saito, and Yu Sadachi: Employment (Daiichi Sankyo Co., Ltd.). Ayumi Shintani: Consultancies (paid to her or her institution) (Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Kyowa Kirin Co., Ltd., Takeda Pharmaceutical Co., Ltd., Shionogi & Co., Ltd., and Mallinckrodt Pharma K.K.); Honoraria (AbbVie G.K., Asahi Kasei Pharma Corporation, AstraZeneca K.K., Astellas Pharma Inc., Bayer Yakuhin, Ltd., Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Kissei Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., Mallinckrodt Pharma K.K., Merck Biopharma Co., Ltd., Maruho Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Nipro Corporation, Novo Nordisk Pharma Ltd., Nippon Shinyaku Co., Ltd., Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Torii Pharmaceutical Co., Ltd., Sanofi K.K., Nippon Kayaku Co., Ltd., JCR Pharmaceuticals Co., Ltd., and MSD K.K.); and Grants (Daiichi Sankyo Co., Ltd.).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was conducted per the principles of the Declaration of Helsinki (as revised in 2013) and the Act on the Protection of Personal Information (Act No. 57 of 30 May 2003). The study was registered in the University Hospital Medical Information Network Clinical Trials Registry under the identifier UMIN000054749 on 1 July 2024.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants"}},{"value":"Because this was a retrospective analysis of claims data using fully anonymized data, the requirement for review by an ethics committee was waived, and informed consent was not required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}