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This study analysed the association between the current biochemical parameters of chronic kidney disease\u2013mineral and bone disorders (CKD-MBD) and bone fragility fractures in the COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) project.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>COSMOS is a 3-year, multicentre, open cohort, prospective, observational study carried out in 6797 haemodialysis patients (227 centres from 20 European countries). The association of bone fragility fractures (outcome) with serum calcium, phosphate and parathyroid hormone (PTH) (exposure), was assessed using standard Cox proportional hazards regression and Cox proportional hazards regression for recurrent events. Additional analyses were performed considering all-cause mortality as a competitive event for bone fragility fracture occurrence. Multivariable models were used in all strategies, with the fully adjusted model including a total of 24 variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow-up of 24\u00a0months, 252 (4%) patients experienced at least one bone fragility fracture (incident bone fragility fracture rate 28.5 per 1000 patient-years). In the fractured and non-fractured patients, the percentage of men was 43.7% and 61.4%, mean age 68.1 and 63.8\u00a0years and a haemodialysis vintage of 55.9 and 38.3\u00a0months, respectively. Baseline serum phosphate &amp;gt;6.1\u00a0mg\/dL (reference value 4.3\u20136.1\u00a0mg\/dL) was significantly associated with a higher bone fragility fracture risk in both regression models {hazard ratio (HR) 1.53 [95% confidence interval (CI) 1.10\u20132.13] and HR 1.44 (95% CI 1.02\u20132.05)}. The significant association persisted after competitive risk analysis [subHR 1.42 (95% CI 1.02\u20131.98)] but the finding was not confirmed when serum phosphate was considered as a continuous variable. Baseline serum calcium showed no association with bone fragility fracture risk in any regression model. Baseline serum PTH &amp;gt;800\u00a0pg\/mL was significantly associated with a higher bone fragility fracture risk in both regression models, but the association disappeared after a competitive risk analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hyperphosphatemia was independently and consistently associated with an increased bone fracture risk, suggesting serum phosphate could be a novel risk factor for bone fractures in haemodialysis patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfad190","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T16:32:57Z","timestamp":1693499577000},"page":"618-626","source":"Crossref","is-referenced-by-count":35,"title":["Serum phosphate is associated with increased risk of bone fragility fractures in haemodialysis patients"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6807-3914","authenticated-orcid":false,"given":"Pedro","family":"Barrera-Baena","sequence":"first","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA), Bone and Mineral Research Unit, REDinREN and RICORS2040 del ISCIII , Oviedo , Spain"},{"name":"Hospital Universitario de Cabue\u00f1es, Department of Nephrology , Gij\u00f3n , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minerva","family":"Rodr\u00edguez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA), Bone and Mineral Research Unit, REDinREN and RICORS2040 del ISCIII , Oviedo , Spain"},{"name":"Hospital Universitario Central de Asturias, Department of Nephrology, REDinREN del ISCIII , Oviedo , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Rodr\u00edguez-Rubio","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA), Bone and Mineral Research Unit, REDinREN and RICORS2040 del ISCIII , Oviedo , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Gonz\u00e1lez-Llorente","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA), Bone and Mineral Research Unit, REDinREN and RICORS2040 del ISCIII , Oviedo , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-9523","authenticated-orcid":false,"given":"Alberto","family":"Ortiz","sequence":"additional","affiliation":[{"name":"IIS-Fundacion Jimenez Diaz UAM, Department of Nephrology and Hypertension , Madrid , Spain"},{"name":"RICORS2040 ; Madrid , Spain"},{"name":"Universidad Aut\u00f3noma de Madrid, Facultad de Medicina, Departamento de Medicina , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6616-1996","authenticated-orcid":false,"given":"Carmine","family":"Zoccali","sequence":"additional","affiliation":[{"name":"Ospedali Riuniti CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit , Foggia , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7505-261X","authenticated-orcid":false,"given":"Francesco","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Alessandro Manzoni Hospital, Department of Nephrology, Dialysis and Renal Transplant , ASST Lecco , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Floege","sequence":"additional","affiliation":[{"name":"RWTH Aachen University, Div. 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