Skeletal Muscle Mass Index Is Positively Associated With Bone Mineral Density in Hemodialysis Patients

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2020 Jun 2

PMID 32478086

Citations 11

Authors

Kiyonori Ito

Susumu Ookawara

Yutaka Hibino

Sojiro Imai

Mariko Fueki

Yusaku Bandai

Masatoshi Yasuda

Tatsuya Kamimura

Hideo Kakuda

Satoshi Kiryu

Noriko Wada

Yuri Hamashima

Tadanao Kobayashi

Mitsutoshi Shindo

Hidenori Sanayama

Yasushi Ohnishi

Kaoru Tabei

Yoshiyuki Morishita

Affiliations

Soon will be listed here.

Abstract

Patients with chronic kidney disease (CKD) are at risk for bone loss and sarcopenia because of associated mineral and bone disorders (MBD), malnutrition, and chronic inflammation. Both osteoporosis and sarcopenia are associated with a poor prognosis; however, few studies have evaluated the relationship between muscle mass and bone mineral density (BMD) in hemodialysis (HD) patients. The present study examined the association between skeletal muscle mass index (SMI) and BMD in the lumbar spine and femoral neck in HD patients. Fifty HD patients (mean age, 69 ± 10 years; mean HD duration, 9.0 ± 8.8 years) in Minami-Uonuma City Hospital were evaluated. BMD was measured by dual-energy X-ray absorptiometry, and SMI was measured by bioelectrical impedance analysis (InBody) after HD. The factors affecting lumbar spine and femoral neck BMD were investigated, and multivariate analysis was performed. In simple linear regression analysis, the factors that significantly affected the lumbar spine BMD were sex, presence of hypertension, presence of diabetes mellitus, body mass index, triglyceride level, grip strength, and SMI; the factors that significantly affected the femoral neck BMD were sex, HD duration, serum creatinine level, tartrate-resistant acid phosphatase 5b level, undercarboxylated osteocalcin (ucOC) level, N-terminal propeptide of type I procollagen level, grip strength, and SMI. In multivariate analysis, SMI (standardized coefficient: 0.578) was the only independent factor that affected the lumbar spine BMD; the independent factors that affected the femoral neck BMD were SMI (standardized coefficient: 0.468), ucOC (standardized coefficient: -0.366) and sex (standardized coefficient: 0.231). SMI was independently associated with the BMD in the lumbar spine and femoral neck in HD patients. The preservation of skeletal muscle mass could be important to prevent BMD decrease in HD patients, in addition to the management of CKD-MBD.

Citing Articles

Nutritional Intervention and Musculoskeletal Health in Chronic Kidney Disease.

Moldovan D, Rusu C, Potra A, Tirinescu D, Ticala M, Maslyennikov Y Nutrients. 2025; 17(5).

PMID: 40077766 PMC: 11901936. DOI: 10.3390/nu17050896.

Depression as a risk factor for osteoporosis independent of sarcopenia in hemodialysis patients: findings from a multicenter cross-sectional study.

Hu X, Ye X, Chen H, Wu B, Guo Q, Yu C BMC Nephrol. 2025; 26(1):35.

PMID: 39849392 PMC: 11755883. DOI: 10.1186/s12882-025-03963-1.

Skeletal Muscle Measurements Based on Abdominal Computerized Tomography (CT) Predict Risk of Osteoporosis in Incident Hemodialysis Patients.

Park H, Han S, Hwang Y, Choi W, Hong Y, Chang Y J Clin Med. 2025; 13(24.

PMID: 39768620 PMC: 11680026. DOI: 10.3390/jcm13247696.

Association between psoas muscle mass index and bone mineral density in patients undergoing hemodialysis.

Ito K, Ookawara S, Sanayama H, Kakuda H, Kanai C, Iguchi K Sci Rep. 2025; 15(1):544.

PMID: 39748056 PMC: 11696570. DOI: 10.1038/s41598-024-84873-4.

Skeletal muscle index based on CT at the 12th thoracic spine level can predict osteoporosis and fracture risk: a propensity score-matched cohort study.

Hu J, Jin Y, Wu J, Ni J Front Med (Lausanne). 2024; 11:1387807.

PMID: 38725469 PMC: 11079204. DOI: 10.3389/fmed.2024.1387807.

References

Purser J, Kuchibhatla M, Fillenbaum G, Harding T, Peterson E, Alexander K . Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc. 2006; 54(11):1674-81. DOI: 10.1111/j.1532-5415.2006.00914.x. View

Yoshimura N, Muraki S, Oka H, Iidaka T, Kodama R, Kawaguchi H . Is osteoporosis a predictor for future sarcopenia or vice versa? Four-year observations between the second and third ROAD study surveys. Osteoporos Int. 2016; 28(1):189-199. DOI: 10.1007/s00198-016-3823-0. View

Polidoulis I, Beyene J, Cheung A . The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women--a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int. 2011; 23(1):39-51. DOI: 10.1007/s00198-011-1734-7. View

Chen S, Chung W, Wu P, Huang J, Chiu Y, Chang J . Associations among Geriatric Nutrition Risk Index, bone mineral density, body composition and handgrip strength in patients receiving hemodialysis. Nutrition. 2019; 65:6-12. DOI: 10.1016/j.nut.2019.02.013. View

Tentori F, McCullough K, Kilpatrick R, Bradbury B, Robinson B, Kerr P . High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int. 2013; 85(1):166-73. PMC: 3910091. DOI: 10.1038/ki.2013.279. View

Tominaga H, Oku M, Arishima Y, Ikeda T, Ishidou Y, Nagano S . Association between bone mineral density, muscle volume, walking ability, and geriatric nutritional risk index in hemodialysis patients. Asia Pac J Clin Nutr. 2018; 27(5):1062-1066. DOI: 10.6133/apjcn.052018.03. View

Yanishi M, Kinoshita H, Tsukaguchi H, Kimura Y, Koito Y, Sugi M . Factors Related to Osteosarcopenia in Kidney Transplant Recipients. Transplant Proc. 2018; 50(10):3371-3375. DOI: 10.1016/j.transproceed.2018.04.032. View

Hamano T . Mineral and bone disorders in conventional hemodialysis: Challenges and solutions. Semin Dial. 2018; 31(6):592-598. DOI: 10.1111/sdi.12729. View

Heiwe S, Jacobson S . Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis. 2014; 64(3):383-93. DOI: 10.1053/j.ajkd.2014.03.020. View

10.

Alem A, Sherrard D, Gillen D, Weiss N, Beresford S, Heckbert S . Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000; 58(1):396-9. DOI: 10.1046/j.1523-1755.2000.00178.x. View

11.

Nakanishi K, Shishido K, Kumata C, Ito K, Nakashima Y, Wakasa M . Bone density of the femoral neck in patients on maintenance dialysis. PLoS One. 2018; 13(5):e0197965. PMC: 5967790. DOI: 10.1371/journal.pone.0197965. View

12.

Grzegorzewska A, Mlot-Michalska M . Total body mass is better than body mass index as a prognostic parameter for bone mineral density in dialyzed patients. Adv Perit Dial. 2009; 25:178-80. View

13.

Kanazawa Y, Nakao T, Murai S, Okada T, Matsumoto H . Diagnosis and prevalence of protein-energy wasting and its association with mortality in Japanese haemodialysis patients. Nephrology (Carlton). 2016; 22(7):541-547. DOI: 10.1111/nep.12814. View

14.

Yoshimura N, Muraki S, Oka H, Iidaka T, Kodama R, Horii C . Do sarcopenia and/or osteoporosis increase the risk of frailty? A 4-year observation of the second and third ROAD study surveys. Osteoporos Int. 2018; 29(10):2181-2190. DOI: 10.1007/s00198-018-4596-4. View

15.

Mori K, Nishide K, Okuno S, Shoji T, Emoto M, Tsuda A . Impact of diabetes on sarcopenia and mortality in patients undergoing hemodialysis. BMC Nephrol. 2019; 20(1):105. PMC: 6437886. DOI: 10.1186/s12882-019-1271-8. View

16.

Iimori S, Mori Y, Akita W, Kuyama T, Takada S, Asai T . Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study. Nephrol Dial Transplant. 2011; 27(1):345-51. DOI: 10.1093/ndt/gfr317. View

17.

Kohlmeier M, Saupe J, Shearer M, Schaefer K, Asmus G . Bone health of adult hemodialysis patients is related to vitamin K status. Kidney Int. 1997; 51(4):1218-21. DOI: 10.1038/ki.1997.166. View

18.

Miki T, Nakatsuka K, Naka H, Kitatani K, Saito S, Masaki H . Vitamin K(2) (menaquinone 4) reduces serum undercarboxylated osteocalcin level as early as 2 weeks in elderly women with established osteoporosis. J Bone Miner Metab. 2003; 21(3):161-5. DOI: 10.1007/s007740300025. View

19.

Iseri K, Qureshi A, Dai L, Ripsweden J, Heimburger O, Barany P . Bone mineral density at different sites and 5 years mortality in end-stage renal disease patients: A cohort study. Bone. 2019; 130:115075. DOI: 10.1016/j.bone.2019.115075. View

20.

Vergnaud P, Garnero P, Meunier P, Breart G, Kamihagi K, Delmas P . Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women: the EPIDOS Study. J Clin Endocrinol Metab. 1997; 82(3):719-24. DOI: 10.1210/jcem.82.3.3805. View