Clinical and economic burden of fractures in patients with renal osteodystrophy

Schumock, GT; Sm, Sprague

doi:10.5414/cnp67201

Cited by 20 publications

(12 citation statements)

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“…The CKD-EPI-Cys formula might be a useful tool to assess skeletal-related event risks. Given the adverse health consequences and economic burden associated with fractures [ 35 , 36 ], identifying the cut-off of eGFR for increased risk of fractures would be important. The gender-specific effect of PTH on the relationship between eGFR and BMD needs to be confirmed.…”

Section: Discussionmentioning

confidence: 99%

Association of renal function with bone mineral density and fracture risk in the Longitudinal Aging Study Amsterdam

et al. 2018

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SummaryEarly renal dysfunction is associated with a 38% increased fracture risk in individuals aged 65 years and older. In men but not women, early renal dysfunction is associated with decreased femoral neck bone mineral density (BMD) which can be partially explained by increased parathyroid hormone (PTH) concentrations.IntroductionIt is uncertain whether early renal dysfunction is associated with osteoporosis and increased fracture risk. The aim of this study was to determine the relationship of decreased renal function with BMD and fracture risk and the role of PTH therein.MethodsWe analyzed data of participants aged 65 years and older from the Longitudinal Aging Study Amsterdam. A 6-year fracture follow-up was obtained in 1477 participants. BMD was measured by dual-energy x-ray absorptiometry (n = 535) and vertebral fractures by lateral spinal radiograph (n = 527) in a subsample at baseline. Glomerular filtration rate (eGFR) was estimated according to the modification of diet in renal disease equation and assessed by the five stages of chronic kidney disease (CKD).ResultsIn men and women, eGFR < 57 ml/min/1.73 m2 (lowest quartile) compared to eGFR > 74 ml/min/1.73 m2 (highest quartile) was associated with a 38% increase in fracture risk after adjustment for relevant confounders [hazard ratio (95%CI): 1.38 (1.17 to 1.61)]. Also, CKD stages 3a and 3b were associated to a 28 and 46% increase in fracture risk, respectively, as compared to CKD stages 1 and 2 together (eGFR > 60 ml/min/1.73 m2) after adjustment for confounders. Renal function was not associated with prevalent vertebral fractures. In men, but not women, lowest quartile of eGFR was related to lower femoral neck BMD as compared to the highest quartile eGFR [unstandardized B (95%CI) − 0.052 g/cm2 (− 0.098 to − 0.006)], after adjustment for relevant confounders. Further adjustment for PTH attenuated this relationship by 27%.ConclusionsIn men and women, early decreased renal function (eGFR < 60 ml/min/1.73 m2) was related to increased incident any fracture risk but not with increased prevalence of vertebral fractures. In men, but not women, early renal dysfunction was related to lower femoral neck BMD which could statistically be partially explained by increased PTH concentrations.

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Section: Discussionmentioning

confidence: 99%

Association of renal function with bone mineral density and fracture risk in the Longitudinal Aging Study Amsterdam

et al. 2018

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“…In patients with stage 4 CKD, the risk of hip fracture has been reported to be almost 4-fold that of the general population without CKD (14). Thus, the healthcare costs associated with renal osteodystrophy and secondary fracture are substantial (15).…”

Section: Introductionmentioning

confidence: 99%

Osteoprotective effects of osthole in a mouse model of 5/6 nephrectomy through inhibiting osteoclast formation

Xue

Wang

et al. 2016

Molecular Medicine Reports

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The present study aimed to investigate the effects of osthole on osteoclast formation and bone loss in a mouse model of 5/6 nephrectomy. The mice in control and osthole groups were treated 1 month following 5/6 nephrectomy with either a placebo or osthole, respectively. At 2 months post‑nephrectomy, the L4 vertebrae were harvested. The bone mineral density (BMD) of cancellous bone was measured using micro‑CT and tartrate‑resistant acid phosphatase (TRAP) staining was performed to evaluate osteoclast formation. Immunohistochemistry staining and reverse transcription‑quantitative polymerase chain reaction were performed to detect the expression of nuclear factor of activated T‑cells, cytoplasmic‑1 (NFATc‑1), c‑Fos, cathepsin K, Trap, matrix metalloproteinase 9 (Mmp9), osteoprotegerin (Opg) and receptor activator for nuclear factor‑κB ligand (Rankl). Bone marrow cells were cultured with osthole, and osteoclast formation was shown by TRAP staining. Primary calvaria osteoblasts were cultured with osthole, and expression levels of Opg and Rankl were detected. Compared with the sham group, the BMD of mice in model group was significantly reduced. The numbers of osteoclasts and the expression levels of NFATc‑1, c‑Fos, cathepsin K and Mmp9 were significantly increased. Compared with the control group, the mice in the osthole group exhibited increased BMD of the L4 vertebrae, a reduction in osteoclast numbers and decreased expression levels of NFATc‑1, c‑Fos, cathepsin K and Mmp9. In vitro experiments also showed that osteoclast formation was decreased following treatment with osthole. Osteoprotegerin (Opg)/receptor activator for nuclear factor‑κB ligand (Rankl) was upregulated by osthole treatment in the L4 vertebrae and in primary cultures of calvarial osteoblasts. Osthole inhibited osteoclast formation and partially reversed the bone loss induced by 5/6 nephrectomy in mice through the upregulation of OPG/RANKL.

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“…Given the adverse health consequences and economic burden associated with fractures (17,18), identifying whether earlier stages of CKD increase the risk for fractures would be important for designing future interventions. Therefore, we sought to determine the association between eGFR and rates of fractures of the hip, wrist, and vertebrae among adult residents of Alberta, Canada.…”

Section: Introductionmentioning

confidence: 99%

Estimated GFR and Fracture Risk

Elliott¹,

James

Quinn³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Although patients with ESRD have a higher fracture risk than the general population, there is conflicting evidence regarding fracture incidence in those with CKD. This study sought to determine the association between estimated GFR (eGFR) and fracture rates.Design, setting, participants, & measurements This study identified 1,815,943 community-dwelling adults who had at least one outpatient serum creatinine measurement between 2002 and 2008. Patients with eGFR ,15 ml/min per 1.73 m 2 and those who required dialysis were excluded. Incident fractures of the hip, wrist, and vertebrae were identified using diagnostic and procedure codes. Poisson regression was used to determine adjusted rates of each fracture type by eGFR, age, and sex.Results The median age of the cohort was 47 years (interquartile range, 24), and 7.1% had eGFR ,60 ml/min per 1.73 m 2 . Over a median follow-up of 4.4 years, fracture rates increased with age at all sites. Within each age stratum, unadjusted rates increased with declining eGFR; however, adjusted rates were similar across eGFR categories. For example, among women aged 65-74 years, adjusted hip fracture rates were 3.41 per 1000 personyears (95% confidence interval, 2.30 to 4.53) and 4.58 per 1000 person-years (95% confidence interval, 0.02 to 9.14) in those with eGFR $90 and 15-29 ml/min per 1.73 m 2 , respectively. Similar results were observed for wrist and vertebral fractures. ConclusionsIn contrast to earlier studies, patients with eGFR,60 ml/min per 1.73 m 2 do not appear to have increased rates of hip, wrist, and vertebral fractures independent of age and sex.

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Clinical and economic burden of fractures in patients with renal osteodystrophy

Cited by 20 publications

References 0 publications

Association of renal function with bone mineral density and fracture risk in the Longitudinal Aging Study Amsterdam

Association of renal function with bone mineral density and fracture risk in the Longitudinal Aging Study Amsterdam

Osteoprotective effects of osthole in a mouse model of 5/6 nephrectomy through inhibiting osteoclast formation

Estimated GFR and Fracture Risk

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