A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

Hampson, Geeta; Elder, Grahame J.; Cohen‐Solal, Martine; Abrahamsen, Bo

doi:10.1007/s12020-021-02735-9

Cited by 21 publications

(26 citation statements)

References 156 publications

(201 reference statements)

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“…In elderly subjects, hyperparathyroidism may be due to vitamin D deficiency [ 45 ] and to the chronic kidney disease. In fact, serum PTH values generally increase when estimated glomerular filtration rate falls below 60 mL/min/1.73 m2 [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the diagnostic delay of acromegaly on bone health: data from a real life and long term follow-up experience

et al. 2022

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Introduction Acromegaly is a chronic disease with systemic complications. Disease onset is insidious and consequently typically burdened by diagnostic delay. A longer diagnostic delay induces more frequently cardiovascular, respiratory, metabolic, neuropsychiatric and musculoskeletal comorbidities. No data are available on the effect of diagnostic delay on skeletal fragility. We aimed to evaluate the effect of diagnostic delay on the frequency of incident and prevalent of vertebral fractures (i-VFs and p-VFs) in a large cohort of acromegaly patients. Patients and methods A longitudinal, retrospective and multicenter study was conducted on 172 acromegaly patients. Results Median diagnostic delay and duration of follow-up were respectively 10 years (IQR: 6) and 10 years (IQR: 8). P-VFs were observed in 18.6% and i-VFs occurred in 34.3% of patients. The median estimated diagnostic delay was longer in patients with i-VFs (median: 11 years, IQR: 3), in comparison to those without i-VFs (median: 8 years, IQR: 7; p = 0.02). Age at acromegaly diagnosis and at last follow-up were higher in patients with i-VFs, with respect to those without i-VFs. The age at acromegaly diagnosis was positively associated with the diagnostic delay (p < 0.001, r = 0.216). A longer history of active acromegaly was associated with a high frequency of i-VFs (p = 0.03). The logistic regression confirmed that patients with a diagnostic delay > 10 years had 1.5-folds increased risk of developing i-VFs (OR: 1.5; 95%CI: 1.1–2; p = 0.017). Conclusion Our data showed that the diagnostic delay in acromegaly has a significant impact on VF risk, further supporting the clinical relevance of an early acromegaly diagnosis.

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Section: Discussionmentioning

confidence: 99%

Impact of the diagnostic delay of acromegaly on bone health: data from a real life and long term follow-up experience

et al. 2022

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“…There is also evidence that women are more susceptible to CKD [ 14 ] and women are an independent risk factor for fracture in hemodialysis patients [ 15 ]. Therefore, in CKD patients with fracture, the result that there are more women than men is no exception [ 16 ]. Among the patients, we included 80–84 years old CKD with fracture accounted for the largest proportion.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and complications of fracture in older adults with chronic kidney disease: a cross-sectional study

Guo

et al. 2022

J Orthop Surg Res

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Background The aim of this study was to analyze the clinical characteristics of older fracture patients with chronic kidney disease (CKD) and to determine the risk factors of perioperative cardiovascular complications. Methods We retrospectively reviewed clinical data of older fracture patients with CKD admitted to the Third Hospital of Hebei Medical University from January 2016 to October 2021. The data we collected included baseline characteristics and complications. We finally determined the risk factors of perioperative cardiovascular complications by using logistic regression. Results We ended up enrolling 224 patients, and there were 91 (40.6%) males and 133 (59.4%) females, with a median age of 79 years. 80–84 years old was the age group with high incidence of fracture. The majority of fracture occurred indoors (130 cases, 58.0%) and morning (98 cases, 43.8%). Hip fracture was most common (183 cases, 81.7%), of which femoral neck fracture (101 cases, 45.0%) was the most prevalent. The most common comorbid condition was hypertension (171 cases, 76.3%), and anemia was the most common complication (148 cases, 66.1%). Age ≥ 80 years (OR = 2.023, 95% CI 1.110–3.688), previously combined with cardiovascular calcification (OR = 1.901, 95% CI 1.047–3.451) and admission hemoglobin level < 100 g/L (OR = 3.191, 95% CI 1.744–5.838) were independent risk factors of perioperative cardiovascular disease (CVD). Conclusion It was especially necessary to enhance fracture prevention for CKD. Patients whose age older than 80, hemoglobin less than 100 g/L on admission and have previous cardiovascular calcification are more likely to develop perioperative CVD. Such patients require reasonable decisions during the perioperative period to avoid the occurrence of CVD.

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“… 98 In CKD stage 4 with high risk of fracture in younger adults, Hampson suggested considering denosumab or off-label prescription of bisphosphonate. 99 …”

Section: Need For Novel Comprehensive Approach In Concomitant Decline...mentioning

confidence: 99%

Managing Musculoskeletal and Kidney Aging: A Call for Holistic Insights

Cailleaux¹,

Cohen‐Solal²

2022

CIA

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Aging represents a major concern, with a two-fold increase in individuals >65 years old by 2040. Older patients experience multiple declines in condition, with overlapping concerns. Fractures, frailty and falls remain underestimated events in routine practice. They are shared by numerous conditions and diseases, such as osteoporosis, sarcopenia and undernutrition, which mostly feature low evolution and are silent. In this review, we focused on musculoskeletal decline in older individuals who also have chronic kidney disease (CKD), which promotes fractures and falls. We aimed to highlight the need for a global approach for musculoskeletal and kidney aging. Although strategies limiting falls remain controversial, the need for an early diagnosis can limit these declines and allow for specific treatment of bone fragility in addition to non-pharmacological approaches. The emergence of senolytic agents offers new hope for preventing musculoskeletal disorders. This scoping review describes these overlapping silent diseases, provides evidence for their global understanding and management, and sheds light on new therapeutic directions.

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A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

Cited by 21 publications

References 156 publications

Impact of the diagnostic delay of acromegaly on bone health: data from a real life and long term follow-up experience

Impact of the diagnostic delay of acromegaly on bone health: data from a real life and long term follow-up experience

Characteristics and complications of fracture in older adults with chronic kidney disease: a cross-sectional study

Managing Musculoskeletal and Kidney Aging: A Call for Holistic Insights

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