Subgroup-Specific Osteoporosis Risk in Chronic Kidney Disease: Insights from a Nationwide Korean Cohort

Background/Objectives: Chronic kidney disease (CKD) and osteoporosis are critical public health concerns, particularly among older adults, due to their prevalence and associated complications. While CKD-related disruptions in bone mineral metabolism are believed to increase osteoporosis risk, this relationship remains unclear in diverse populations such as Korea. Methods: This longitudinal cohort study utilized data from the Korean National Health Insurance Service Health Screening Cohort (2002–2019), including 13,622 patients with newly diagnosed CKD and 54,488 matched controls. CKD was defined as having at least two outpatient or inpatient records with ICD-10 codes N18 or N19 and/or evidence of dialysis treatment claims, following a 1-year washout period to exclude prevalent cases. Individuals with a prior history of osteoporosis or incomplete baseline data were excluded. Propensity score overlap weighting was applied, and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, with subgroup analyses based on demographic and clinical factors. Results: CKD was not associated with an increased risk of osteoporosis. On the contrary, CKD patients exhibited an 18% lower risk of developing osteoporosis compared to controls (HR = 0.82, 95% CI: 0.77–0.87, p < 0.001). This inverse association was more pronounced among women, non-smokers, individuals with low alcohol consumption, and those with a higher comorbidity burden. Conclusions: These findings suggest that certain subgroups of CKD patients may have a reduced risk of osteoporosis, highlighting the importance of individualized risk assessment and tailored preventive strategies.