Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional, longitudinal study

Nybo, Mads; Jespersen, Bente; Aarup, Michael; Ejersted, Charlotte; Hermann, Anne Pernille; Brixen, Kim

doi:10.11613/bm.2013.042

Cited by 11 publications

(9 citation statements)

References 26 publications

(35 reference statements)

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“…Several studies are consistent with our study showing that BMD decreased as age increased [14,17,18]. The effect of gender on bone mass in hemodialysis is controversial [19,20]. We found that BMD was significantly lower in women at the total body.…”

Section: Discussionsupporting

confidence: 92%

Mineral bone disorder and osteoporosis in hemodialysis patients

et al. 2020

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Background: Bone disease is common in patients undergoing hemodialysis. It is the result of bone turnover abnormalities and the decrease of bone mineral density (BMD). We aimed to determine the usefulness of serum bone turnover markers and BMD measurement by dual-energy x-ray absorptiometry (DXA) in hemodialysis patients. Methods: We conducted a cross-sectional study including 90 hemodialysis for more than 12 months. Bone mineral density was assessed by DXA. Peripheral blood samples were obtained from each patient before dialysis in a fasting state within a week of the DXA. Biochemical variables of calcium and phosphate were measured. One bone formation marker (bone-specific alkaline phosphatase (bAP), one bone resorption marker (carboxy-terminal telopeptides of type 1 collagen (CTX)) were measured. Total alkaline phosphatase (TAP), intact parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) which is a bone-derived hormone were also measured. Results: CTX values were 6.25 times higher than the normal limit of the assay. Bone alkaline phosphatase levels were less than 10 ng/mL in 28.8% of cases. 23% of patients have osteoporosis and 45% have osteopenia. Femoral BMD had negative correlations with age and PTH levels. FGF23 levels were significantly increased in patients with osteoporosis affecting the lumbar. The levels of bAP and CTX showed a positive correlation. Both circulating bAP and CTX levels showed also positive correlations with PTH levels. Fractures, observed in 12.2% of cases, were associated with low PTH values and the existence of osteoporosis. Conclusions: Our study showed that osteoporosis and fracture are common in dialysis patients. The reduced BMD was associated with advanced age and elevated levels of PTH. Markers of bone turnover and FGF23 may play a role in the diagnosis of bone disease in hemodialysis patients. DXA measurement is necessary for the monitoring for bone loss.

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Section: Discussionsupporting

confidence: 92%

Mineral bone disorder and osteoporosis in hemodialysis patients

et al. 2020

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“…No differences were found in BMD between hemodialysis and peritoneal dialysis [17]. Low BMD also represents an independent mortality risk factor [18].…”

Section: Introductionmentioning

confidence: 88%

Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients

Brunerová

Ronová

Verešová

et al. 2016

Kidney Blood Press Res

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Background/Aims: Small attention is paid to other types of bone diseases then chronic kidney disease-mineral and bone disorder in dialysis patients. The aim of our study was to assess the occurrence of osteoporosis and bone microarchitecture by trabecular bone score in this population. Methods: 59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafIltration underwent densitometry (Lunar Prodigy, TBS software 2.1.2) and laboratory assessment. Results: Osteoporosis was observed in 34% patients, high bone turnover was found in 80% of them, with SHPT (PTH > 300 ng/l) present in 69%. TBS was significantly decreased in 47.5% of the patients. TBS correlated with T- and Z-scores of the lumbar spine and proximal femur in the total population (P < 0.0001) and in men (P < 0.00001) and there were significant differences between TBS in groups with normal densitometry, osteopenia, and osteoporosis, both in total population (P < 0.0001; P < 0.01) and in men (P < 0.001; P < 0.001). Conclusions: Osteoporosis was found in about 1/3 of patients treated with hemodiafiltration. Normal TBS was found in only 1/4 of the dialysis population. TBS correlated with densitometric parameters and was significantly different relative to T-scores.

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“…Lastly, although our studies demonstrated an association between HD status and the higher risk of hip fracture, data on BMD among ESRD patients in included studies were limited. In addition, current evidence on the benefits of interventions to improve BMD on the improvement of fracture rates in ESRD patients remains controversial . However, the findings of our study highlight the need for future studies on the prevention of hip fractures among ESRD patients undergoing HD.…”

Section: Discussionmentioning

confidence: 79%

“…It is unclear if the difference in dialysis modality influences the hip fracture risk among ESRD patients and, if so, which modality has less risk. Each dialysis modality causes physiological changes that may affect the bone and mineral metabolism differently . The choice of renal replacement therapy usually depends on several important factors.…”

Section: Introductionmentioning

confidence: 99%

Risk of hip fracture in patients on hemodialysis versus peritoneal dialysis: A meta‐analysis of observational studies

Boonpheng

Mao

Wijarnpreecha

et al. 2019

J Evidence Based Medicine

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Background: Bone and mineral metabolism disorders are common among end-stage renal disease (ESRD) patients, which could lead to hip fracture. It is unclear whether the hip fracture risk is different among patients on hemodialysis (HD) versus peritoneal dialysis (PD). This meta-analysis was conducted to evaluate the hip fracture risk in ESRD patients on HD, when compared to PD. Methods: A literature review was conducted in EMBASE, MEDLINE, and Cochrane databasesthrough January 31, 2018 to identify studies that appraised the rate or risk of hip fracture among patients on HD, when compared to PD. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, generic inverse variance approach of DerSimonian and Laird.Results: Five cohort studies with 1 276 677 ESRD patients were enrolled. HD status was associated with a significantly higher risk of hip fracture with the pooled odds ratio (OR) of 1.61 (95% confidence interval [CI] 1.50-1.73, I 2 = 10.0%), compared with PD. When the analysis was limited to studies with confounder-adjusted analysis, the pooled OR of hip fracture among HD patients was 1.57 (95% CI 1.43-1.72, I 2 = 13.6%). Funnel plots and Egger's regression test demonstrated no significant publication bias in our meta-analysis. Conclusions:Among ESRD patients, HD status is associated with a 61% higher risk of hip fracture compared to PD.

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Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional, longitudinal study

Cited by 11 publications

References 26 publications

Mineral bone disorder and osteoporosis in hemodialysis patients

Mineral bone disorder and osteoporosis in hemodialysis patients

Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients

Risk of hip fracture in patients on hemodialysis versus peritoneal dialysis: A meta‐analysis of observational studies

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