Bone Fragility Fractures in CKD Patients

Pimentel, Ana Laura; Ureña-Torres, Pablo; Bover, Jordi; Fernández-Martín, José Luis; Cohen‐Solal, Martine

doi:10.1007/s00223-020-00779-z

Cited by 37 publications

(38 citation statements)

References 108 publications

(141 reference statements)

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“…Neurological disturbance followed by gait abnormality in chronic hyponatremia can increase the risk of hip fracture [7]. However, individuals of older age, female sex, caucasian race, and low body mass index (BMI) are at a higher likelihood of having a fracture compared to those of younger age, male sex, African American, and high BMI [8]. Therefore, identifying these risk factors and implementing proper management can mitigate adverse outcomes.…”

Section: Review Epidemiology and Risk Factorsmentioning

confidence: 99%

Osteoporosis, an Inevitable Circumstance of Chronic Kidney Disease: A Systematic Review

Tasnim¹,

Dutta

Nayeem

et al. 2021

Cureus

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Nowadays, chronic kidney disease (CKD) and osteoporosis have become crucial health-related issues globally. CKD-induced osteoporosis is a systemic disease characterized by the disruption of mineral, hormone, and vitamin homeostasis that elevates the likelihood of fracture. Here, we review recent studies on the association of CKD and osteoporosis. In particular, we focus on the pathogenesis of CKD-associated osteoporosis, including the homeostasis and pathways of several components such as parathyroid hormone, calcium, phosphate, vitamin D, fibroblast growth factor, and klotho, as well as abnormal bone mineralization, remodeling, and turnover. In addition, we explore the diagnostic tools and possible therapeutic approaches for the management and prevention of CKD-associated osteoporosis. Patients with CKD show higher osteoporosis prevalence, greater fracture rate, increased morbidity and mortality, and an elevated occurrence of hip fracture. We also rule out that increased severity of CKD is related to a more severe condition of osteoporosis. Furthermore, supplements such as calcium and vitamin D as well as lifestyle modifications such as exercise and cessation of smoking and alcohol help in fracture prevention. However, new approaches and advancements in treatment are needed to reduce the fracture risk in patients with CKD. Therefore, further collaborative multidisciplinary research is needed in this regard.

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Section: Review Epidemiology and Risk Factorsmentioning

confidence: 99%

Osteoporosis, an Inevitable Circumstance of Chronic Kidney Disease: A Systematic Review

Tasnim¹,

Dutta

Nayeem

et al. 2021

Cureus

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“…BF events in CKD-MBD stand for the toughest complications that increase the risk of subsequent high rates of hospitalization and mortality dramatically [ 15 , 16 , 17 , 18 ]. However, none of the prior research investigated the association between PCS, NHALP and BF events.…”

Section: Discussionmentioning

confidence: 99%

Circulating p-Cresyl Sulfate, Non-Hepatic Alkaline Phosphatase and Risk of Bone Fracture Events in Chronic Kidney Disease-Mineral Bone Disease

Chang

Hsieh

Liou

et al. 2021

Toxins

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Patients with chronic kidney disease (CKD), especially those undergoing hemodialysis, are at a considerably high risk of bone fracture events. Experimental data indicate that uremic toxins intricately involved in bone-related proteins exert multi-faced toxicity on bone cells and tissues, leading to chronic kidney disease–mineral and bone disorder (CKD-MBD). Nonetheless, information regarding the association between p-cresyl sulfate (PCS), non-hepatic alkaline phosphatase (NHALP) and skeletal events remains elusive. We aim to explore the association between PCS, NHALP and risk of bone fracture (BF) in patients with hemodialysis. Plasma concentrations of PCS and NHALP were ascertained at study entry. Cox proportional hazard regression analyses were used to determine unadjusted and adjusted hazard ratios (aHRs) of PCS for BF risk. In multivariable analysis, NHALP was associated with incremental risks of BFs [aHR: 1.06 (95% CI: 1.01–1.11)]. The association between the highest PCS tertile and BF risk remained robust [aHR: 2.87 (95% CI: 1.02–8.09)]. With respect to BF events, the interaction between NHALP and PCS was statistically significant (p value for the interaction term < 0.05). In addition to mineral dysregulation and hyperparathyroidism in hemodialysis patients, higher circulating levels of PCS and NHALP are intricately associated with incremental risk of BF events, indicating that a joint evaluation is more comprehensive than single marker. In light of the extremely high prevalence of CKD-MBD in the hemodialysis population, PCS may act as a pro-osteoporotic toxin and serve as a potential surrogate marker for skeletal events.

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“…High morbidity and mortality rates correlate tightly with progressive CKD-MBD that are intricately involved in underlying metabolic bone alterations and bone marrow microenvironment (e.g., adipocytes, mesenchymal stem cells, osteoblasts and osteoclasts) [ 10 , 17 , 18 , 19 , 20 ]. Adipocytes in bone marrow, or termed marrow adipose tissue, reside in the bone microenvironment in close contact to all types of bone cells.…”

Section: Discussionmentioning

confidence: 99%

“…Adipocytes in bone marrow, or termed marrow adipose tissue, reside in the bone microenvironment in close contact to all types of bone cells. From bedside to bench, the relationship between the fat-bone axis and osteoporotic BF events is evident [ 10 , 17 , 18 , 19 , 20 ]. Despite these molecular connections between fat and bone, none of the prior research investigated the association between CKD-MBD and the fat-bone axis.…”

Section: Discussionmentioning

confidence: 99%

Fat-Bone Relationship in Chronic Kidney Disease—Mineral Bone Disorders: Adiponectin Is Associated with Skeletal Events among Hemodialysis Patients

et al. 2021

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Background: The risk of skeletal events is rising in parallel with the burden of chronic kidney disease and mineral bone disorder (CKD-MBD), whilst the role of the fat-bone axis in CKD-MBD remains elusive. Adiponectin derived from adipocytes has emerged as a valid biomarker of low bone mineral density and increased marrow adiposity. We aimed to explore the association between adiponectin and bone fracture (BF) risks in patients with maintenance hemodialysis (MHD). Methods: Serum concentrations of adiponectin and bio-clinical data were determined at study entry. The Cox proportional hazard regression analyses were used to assess unadjusted and adjusted hazard ratios (aHRs) of adiponectin and various clinical predictors for BF risks. The predictive accuracy of adiponectin for BF events was evaluated by receiver operating characteristic (ROC) curve analysis. Results: Age and serum concentrations of adiponectin, phosphate, and intact parathyroid hormone were significantly associated with higher risks of BF. With respect to the risk of BF events, the cumulative event-free survival curves differed significantly between the high and low concentration groups of adiponectin (p = 0.02). In multivariable analysis, higher adiponectin levels were associated with an incremental risk of BF (adjusted hazard ratios (aHRs): 1.08 (95% confidence interval (CI): 1.01–1.15), p < 0.05). The ROC analysis of adiponectin cutoff point concentration (18.15 ug/mL) for prediction of BF showed 0.66 (95% CI = 0.49 to 0.84). Conclusion: Adiponectin was associated with an incremental risk of BF that could serve as a potential predictor of BF in MHD patients. In the high-risk population with hyperphosphatemia, an elevated adiponectin level could alert clinicians to the urgent need to correct mineral dysregulation and undertake further bone survey.

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Bone Fragility Fractures in CKD Patients

Cited by 37 publications

References 108 publications

Osteoporosis, an Inevitable Circumstance of Chronic Kidney Disease: A Systematic Review

Osteoporosis, an Inevitable Circumstance of Chronic Kidney Disease: A Systematic Review

Circulating p-Cresyl Sulfate, Non-Hepatic Alkaline Phosphatase and Risk of Bone Fracture Events in Chronic Kidney Disease-Mineral Bone Disease

Fat-Bone Relationship in Chronic Kidney Disease—Mineral Bone Disorders: Adiponectin Is Associated with Skeletal Events among Hemodialysis Patients

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