Determinants of Prevalent Vertebral Fractures and Progressive Bone Loss in Long-term Hemodialysis Patients

Overview

Journal J Bone Miner Metab

Specialty Endocrinology

Date 2009 Jan 28

PMID 19172222

Citations 14

Authors

Jan Mares

Kristina Ohlidalova

Sylvie Opatrna

Jiri Ferda

Affiliations

Soon will be listed here.

Abstract

Skeletal fractures are common in hemodialysis (HD) patients. However, consensus regarding technique and site of bone examination has not been reached in HD patients. Seventy-two patients (44% females) aged 65 (1.4) years, treated with HD for 43 (4.6) months were examined with quantitative computed tomography and 53 of them re-examined after 1 year. Bone mineral density (BMD) of lumbar spine was established separately for cortical and trabecular bone, prevalent vertebral fractures were determined. Data are given as mean (standard error). At least one vertebral fracture was discovered in 15 (21%) patients. In a logistic regression model, fractures were best predicted by cortical BMD: OR 0.96 (CI 0.94, 0.99), p < 0.005. With a multiple regression analysis, time on dialysis was found to be independently correlated to cortical BMD (R = 0.35, p < 0.005). On follow-up, a decrease of BMD was detected, which occurred only in the cortical region and was significantly greater in females than in males: -7% (1.7) versus 1.2% (1.9), p < 0.005. A time-dependent loss of vertebral cortical bone occurs in HD patients, especially in females. This decrement may impose an increased risk of fractures on long-term dialysis patients.

Citing Articles

Association of Preoperative Osteoporotic Vertebral Compression Fractures with Muscle Atrophy in Lumbar Spinal Stenosis: A Retrospective Cohort Study.

Suzuki K, Mizoguchi Y, Hasebe Y, Kimura F, Saita K, Ogihara S Prog Rehabil Med. 2024; 9:20240011.

PMID: 38567018 PMC: 10984831. DOI: 10.2490/prm.20240011.

Bone Marrow Adiposity, Bone Mineral Density and Wnt/β-catenin Pathway Inhibitors Levels in Hemodialysis Patients.

Wang Y, Khelifi N, De Halleux C, Ung R, Samson F, Gagnon C J Bone Metab. 2022; 29(2):113-122.

PMID: 35718928 PMC: 9208902. DOI: 10.11005/jbm.2022.29.2.113.

The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone.

Jansz T, Goto N, van Ballegooijen A, Willems H, Verhaar M, van Jaarsveld B Osteoporos Int. 2019; 31(3):515-524.

PMID: 31728605 PMC: 7076061. DOI: 10.1007/s00198-019-05187-0.

Fracture Risk in Dialysis and Kidney Transplanted Patients: A Systematic Review.

Sidibe A, Auguste D, Desbiens L, Fortier C, Wang Y, Jean S JBMR Plus. 2019; 3(1):45-55.

PMID: 30680363 PMC: 6339558. DOI: 10.1002/jbm4.10067.

Bone turnover markers are associated with bone density, but not with fracture in end stage kidney disease: a cross-sectional study.

Jorgensen H, Winther S, Bottcher M, Hauge E, Rejnmark L, Svensson M BMC Nephrol. 2017; 18(1):284.

PMID: 28874132 PMC: 5586067. DOI: 10.1186/s12882-017-0692-5.

References

Stein M, Packham D, Ebeling P, Wark J, Becker G . Prevalence and risk factors for osteopenia in dialysis patients. Am J Kidney Dis. 1996; 28(4):515-22. DOI: 10.1016/s0272-6386(96)90461-8. View

Jamal S, Gilbert J, Gordon C, Bauer D . Cortical pQCT measures are associated with fractures in dialysis patients. J Bone Miner Res. 2006; 21(4):543-8. DOI: 10.1359/jbmr.060105. View

Duan Y, De Luca V, Seeman E . Parathyroid hormone deficiency and excess: similar effects on trabecular bone but differing effects on cortical bone. J Clin Endocrinol Metab. 1999; 84(2):718-22. DOI: 10.1210/jcem.84.2.5498. View

Malluche H, Monier-Faugere M . Risk of adynamic bone disease in dialyzed patients. Kidney Int Suppl. 1992; 38:S62-7. View

Heaf J . Causes and consequences of adynamic bone disease. Nephron. 2001; 88(2):97-106. DOI: 10.1159/000045968. View

Chertow G, Raggi P, Chasan-Taber S, Bommer J, Holzer H, Burke S . Determinants of progressive vascular calcification in haemodialysis patients. Nephrol Dial Transplant. 2004; 19(6):1489-96. DOI: 10.1093/ndt/gfh125. View

Genant H, Jergas M . Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int. 2003; 14 Suppl 3:S43-55. DOI: 10.1007/s00198-002-1348-1. View

Ito M, Hayashi K, Ishida Y, Uetani M, Yamada M, Ohki M . Discrimination of spinal fracture with various bone mineral measurements. Calcif Tissue Int. 1997; 60(1):11-5. DOI: 10.1007/s002239900178. View

Raggi P, Bellasi A, Ferramosca E, Block G, Muntner P . Pulse wave velocity is inversely related to vertebral bone density in hemodialysis patients. Hypertension. 2007; 49(6):1278-84. DOI: 10.1161/HYPERTENSIONAHA.107.086942. View

10.

Rodriguez Garcia M, Naves Diaz M, Andia J . Bone metabolism, vascular calcifications and mortality: associations beyond mere coincidence. J Nephrol. 2005; 18(4):458-63. View

11.

. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39(2 Suppl 1):S1-266. View

12.

LECHLEITNER P, Krimbacher E, GENSER N, Fridrich L, zur Nedden D, Helweg G . Bone mineral densitometry in dialyzed patients: quantitative computed tomography versus dual photon absorptiometry. Bone. 1994; 15(4):387-91. DOI: 10.1016/8756-3282(94)90814-1. View

13.

Qi Q, Monier-Faugere M, Geng Z, Malluche H . Predictive value of serum parathyroid hormone levels for bone turnover in patients on chronic maintenance dialysis. Am J Kidney Dis. 1995; 26(4):622-31. DOI: 10.1016/0272-6386(95)90599-5. View

14.

Yamaguchi T, Kanno E, Tsubota J, Shiomi T, Nakai M, Hattori S . Retrospective study on the usefulness of radius and lumbar bone density in the separation of hemodialysis patients with fractures from those without fractures. Bone. 1996; 19(5):549-55. DOI: 10.1016/s8756-3282(96)00246-3. View

15.

Barnas U, Schmidt A, Seidl G, Kaider A, Pietschmann P, Mayer G . A comparison of quantitative computed tomography and dual X-ray absorptiometry for evaluation of bone mineral density in patients on chronic hemodialysis. Am J Kidney Dis. 2001; 37(6):1247-52. DOI: 10.1053/ajkd.2001.24529. View

16.

Negri A, Barone R, Quiroga M, Bravo M, Marino A, Fradinger E . Bone mineral density: serum markers of bone turnover and their relationships in peritoneal dialysis. Perit Dial Int. 2004; 24(2):163-8. View

17.

Bervoets A, Spasovski G, Behets G, Dams G, Polenakovic M, Zafirovska K . Useful biochemical markers for diagnosing renal osteodystrophy in predialysis end-stage renal failure patients. Am J Kidney Dis. 2003; 41(5):997-1007. DOI: 10.1016/s0272-6386(03)00197-5. View

18.

Sherrard D, Hercz G, Pei Y, Maloney N, Greenwood C, Manuel A . The spectrum of bone disease in end-stage renal failure--an evolving disorder. Kidney Int. 1993; 43(2):436-42. DOI: 10.1038/ki.1993.64. View

19.

Atsumi K, Kushida K, Yamazaki K, Shimizu S, Ohmura A, Inoue T . Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis. 1999; 33(2):287-93. DOI: 10.1016/s0272-6386(99)70302-1. View

20.

Gerakis A, Hadjidakis D, Kokkinakis E, Apostolou T, Raptis S, Billis A . Correlation of bone mineral density with the histological findings of renal osteodystrophy in patients on hemodialysis. J Nephrol. 2001; 13(6):437-43. View