Parathyroid hormone and alkaline phosphatase are associated with fracture risk in non-dialysis-dependent chronic kidney disease
Authors' conclusion
Our nationwide observational cohort study demonstrates that PTH and ALP were positively associated with fracture risk in non-dialysis-dependent CKDG3-5.
Study context
- Population
- Danish adults with eGFR < 60 ml/min/1.73 m² (non-dialysis-dependent CKDG3–5) and measured parathyroid hormone (PTH), nationwide healthcare registers, 2010–2022
- Participants
- 45,611 adults
- Exposure
- PTH and alkaline phosphatase (ALP) categories vs normal PTH and low to low-normal ALP
- Outcome
- Major osteoporotic fracture (MOF; hip, vertebra, wrist, humerus)
Methodological detailsregistry-based, multiple Cox regression adjusted for relevant confounders
- Registry-based
- Multiple Cox regression adjusted for relevant confounders
Main finding
As reported in the abstract
Hazard ratio (95% CI)P value
High PTHvs Normal PTH
1.15(1.04–1.26)
P = 0.005Very high PTHvs Normal PTH
1.23(1.04–1.46)
P = 0.012Upper-normal ALPvs Low to low-normal ALP
1.11(1.02–1.20)
P = 0.01Slightly elevated ALPvs Low to low-normal ALP
1.29(1.13–1.47)
P < 0.001High ALPvs Low to low-normal ALP
1.59(1.39–1.75)
P < 0.001Observational data: associations, not effects.
Further findings
- Similar HRs of any fracture event stratified by ALP- and PTH levels
Original publication
Parathyroid hormone and alkaline phosphatase are associated with fracture risk in non-dialysis-dependent chronic kidney disease. Osteoporos Int. Published 22 April 2026. doi:10.
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