Bone fracture risk factors in prevalent hemodialysis patients

Matias, Patrícia; Laranjinha, Ivo; Azevedo, Ana; Raimundo, Ana; Navarro, David; Jorge, Cristina; Aires, Inês; Mendes, Marco; Ferreira, Carina; Amaral, Tiago; Gil, Célia; Ferreira, Aníbal

doi:10.1007/s00774-019-01041-9

Cited by 23 publications

(34 citation statements)

References 39 publications

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“…This study shows that VC was significantly associated with incident fracture in female patients with ESRD after adjusting for multiple covariates, while this relationship was not robust in male patients. Although previous reports have shown that VC is a risk factor for fracture in ESRD patients [9,10], a sex-specific association had not Figure 4. Fracture-free survival rates according to the aortic calcification index (ACI) in each sex (Kaplan-Meier curves).…”

Section: Discussionmentioning

confidence: 89%

“…This study shows that VC was significantly associated with incident fracture in female patients with ESRD after adjusting for multiple covariates, while this relationship was not robust in male patients. Although previous reports have shown that VC is a risk factor for fracture in ESRD patients [ 9 , 10 ], a sex-specific association had not been demonstrated. Therefore, these findings suggest that ACI, a marker of VC, may be a reliable marker for future fracture development in female patients with ESRD, although its role appears to be less valuable in male patients.…”

Section: Discussionmentioning

confidence: 91%

“…VC has also been shown to be associated with a low trabecular bone score, a surrogate measure of the microarchitectural integrity of bone, in patients with ESRD [8]. Previous reports have demonstrated that ESRD patients with VC have a high risk for fracture [9,10].…”

mentioning

confidence: 99%

“…In addition, female dialysis patients have been shown to be affected by hip fracture more frequently and at a younger age than male dialysis patients [19]. Female sex has also been identified as an independent predictor for fragility fractures in prevalent hemodialysis patients [10]. These findings suggest a sex-specific difference in the pathogenesis of fracture in patients with ESRD, although little is known about the sex-specific relationship between VC and incident fractures in these patients.…”

mentioning

confidence: 99%

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Sex-specific relationship between vascular calcification and incident fracture in patients with end-stage renal disease

Nam

Hwang

Kim

et al. 2020

Kidney Res Clin Pract

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Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a clinical syndrome that describes a systemic disorder of mineral and bone metabolism caused by CKD. CKD-MBD includes biochemical abnormalities of calcium, phosphorus, parathyroid hormone (PTH), and vitamin D, bone disease, and vascular calcification (VC) [1]. The incidence of fracture increases as CKD progresses [2]. In the Dialysis Outcomes and Practice Patterns Study (DOPPS), across all countries studied the incidence of fracture was significantly higher in patients receiving maintenance dialysis compared with the gen

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Section: Discussionmentioning

confidence: 89%

“…This study shows that VC was significantly associated with incident fracture in female patients with ESRD after adjusting for multiple covariates, while this relationship was not robust in male patients. Although previous reports have shown that VC is a risk factor for fracture in ESRD patients [ 9 , 10 ], a sex-specific association had not been demonstrated. Therefore, these findings suggest that ACI, a marker of VC, may be a reliable marker for future fracture development in female patients with ESRD, although its role appears to be less valuable in male patients.…”

Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Sex-specific relationship between vascular calcification and incident fracture in patients with end-stage renal disease

Nam

Hwang

Kim

et al. 2020

Kidney Res Clin Pract

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“…Higher VC score was independently associated with increased risk of fracture in 341 HD patients. Elderly and female dialysis patients also had higher fracture risk based on a retrospective cohort study [5]. Therefore, VC is an important predictor of possible fracture, especially in postmenopausal women on dialysis.…”

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confidence: 99%

Sex hormones impact vascular calcification and fracture in dialysis patients

2020

Kidney Res Clin Pract

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Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross-Sectional Study

Fusaro

Cianciolo

Tripepi

et al. 2020

Journal of Bone and Mineral Research

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Fractures and vascular calcifications (VCs) are common in patients with chronic kidney disease (CKD). They are related to abnormalities in vitamin D metabolism, calcium, phosphorus, parathyroid hormone, and fibroblast growth factor 23 (FGF23)/Klotho that occur with CKD. Impaired vitamin D metabolism and abnormal levels of calcium, phosphate, parathyroid hormone (PTH), and FGF23/Klotho drive bone and vascular changes in CKD. It is unclear if oral calcitriol safely mitigates fracture risk without increasing the burden of calcifications. Therefore, we investigated whether treatment with calcitriol affected the prevalence of fractures and VC progression in hemodialysis (HD) patients. This report is a secondary analysis of the Vitamin K Italian (VIKI) study, a cross‐sectional study involving 387 HD patients. We assessed vitamin 25(OH)D, alkaline phosphatase, PTH, calcium, phosphate, osteocalcin or bone Gla protein, matrix Gla protein, and vitamin K levels. Vertebral fractures (VFs) and VCs were determined by spine radiograph. A reduction of >20% of vertebral body height was considered a VF. VCs were quantified by the length of calcific lesions along the arteries. The patients treated with oral calcitriol were 177 of 387 patients (45.7%). The prevalence of VF was lower in patients receiving oral calcitriol than in those untreated (48.6% versus 61.0%, p = 0.015), whereas the presence of aortic and iliac calcifications was similar (aortic: 81.9% versus 79.5%, respectively, p = 0.552; iliac: 52.0% and 59.5%, respectively, p = 0.167). In multivariable logistic regression analysis, oral calcitriol was associated with a 40.2% reduced odds of fracture (OR 0.598; 95% confidence interval [CI], 0.363–0.985; p = 0.043). In conclusion, we found a significant association between oral calcitriol and lower VF in HD patients without an increase in the burden of VC. Further prospective and interventional studies are needed to confirm these findings. © 2021 American Society for Bone and Mineral Research (ASBMR).

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Bone fracture risk factors in prevalent hemodialysis patients

Cited by 23 publications

References 39 publications

Sex-specific relationship between vascular calcification and incident fracture in patients with end-stage renal disease

Sex-specific relationship between vascular calcification and incident fracture in patients with end-stage renal disease

Sex hormones impact vascular calcification and fracture in dialysis patients

Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross-Sectional Study

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