Densitometric justification of the diagnosis of osteoporosis in patients with chronic kidney disease stage 5D

Abstract

BACKGROUND. Chronic kidney disease leads to increased bone fragility and fractures. Assessing the risk of fractures is a direct way to prevent them. THE AIM: to assess the possibility of using DXA to predict fracture risk in patients with stage 5D CKD. PATIENTS AND METHODS. The prospective cohort study included 359 patients (166 men, 193 women). BMD was evaluated by DRA. Some markers of mineral and bone metabolism were also analyzed. All fractures in patients were recorded from the moment of inclusion in the study. RESULTS. All patients with fractures had lower BMD and received longer-term renal replacement therapy (RRT). The absolute risk of fractures increased as BMD decreased. Patients with fractures had higher levels of parathyroid hormone and alkaline phosphatase. Stepwise multivariate regression analysis showed that the combination of BMD scores of the forearm, hip, lumbar vertebrae and the duration of RRT best predicts the risk of fractures. The presence of previous fractures also increases risk for the future. Risk of fractures in man and women did not differ. CONCLUSION. The risk of fractures in patients with CKD 5 st. on maintenance hemodialysis increases with a decrease in BMD, an increase in the duration of RRT and the presence of previous fractures, but does not significantly depends on the gender of the patients. It is also can be concluded that it is possible to use criteria reflecting the state of BMD, taking into account their sensitivity and specificity, in assessing the risk of fractures in patients with CKD 5D st.