| Summary: | Background: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (<i>GNRI</i>), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. Methods: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high <i>GNRI</i> group (≥92), considered to have a low risk of malnutrition, and the low <i>GNRI</i> group (<92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high <i>GNRI</i> groups was evaluated by the Kaplan–Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. Results: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low <i>GNRI</i> group compared with the high <i>GNRI</i> group (HR: 3.51, 95% CI: 1.91–6.42, <i>p</i> < 0.01 in males; HR: 2.47, 95% CI: 1.52–4.03, <i>p</i> < 0.01 in females). A low <i>GNRI</i> was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. Conclusions: A low <i>GNRI</i> is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low <i>GNRI</i> group may be important in preventing the occurrence of fractures.
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