Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study

Iimori, Soichiro; Mori, Yoshihiro; Akita, Wataru; Kuyama, Tamaki; Takada, Shigeru; Asai, Tomoki; Kuwahara, Michio; Sasaki, Sei; Tsukamoto, Yusuke

doi:10.1093/ndt/gfr317

Cited by 278 publications

(223 citation statements)

References 21 publications

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“…(4) There were 46 fractures over 40 months, and low BMD at the hip and 1/3 radius predicted fractures. There are no studies in CKD patients not yet on renal replacement therapy (RRT).…”

Section: Introductionmentioning

confidence: 94%

Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

West

Lok

Langsetmo

et al. 2014

Journal of Bone and Mineral Research

168

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Fractures are common in chronic kidney disease (CKD). The optimal methods by which to assess fracture risk are unknown, in part, due to a lack of prospective studies. We determined if bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and/ or high-resolution peripheral quantitative computed tomography (HRpQCT) could predict fractures in men and women !18 years old with stages 3 to 5 CKD. BMD was measured by DXA (at the total hip, lumbar spine, ultradistal, and 1/3 radius) and by HRpQCT (at the radius), and subjects were followed for 2 years for incident morphometric spine fractures and low-trauma clinical fractures. The mean age of the subjects was 62 years with equal numbers having stages 3, 4, and 5 CKD. Over 2 years there were 51 fractures in 35 subjects. BMD by DXA at baseline was significantly lower at all sites among those with incident fractures versus those without. For example, the mean BMD at the total hip in those with incident fractures was 0.77 g/cm 2 (95% confidence interval [CI], 0.73 to 0.80) and in those without fracture was 0.95 g/cm 2 (95% CI, 0.92 to 0.98). Almost all baseline HRpQCT measures were lower in those with incident fracture versus those without. For example, volumetric BMD in those with incident fractures was 232 mg HA/cm 3 (95% CI, 213 to 251) and in those without fracture was 317.6 mg HA/cm 3 (95% CI, 306 to 329.1). Bone loss occurred in all subjects, but was significantly greater among those with incident fractures. Our data demonstrate that low BMD (by DXA and HRpQCT) and a greater annualized percent decrease in BMD are risk factors for subsequent fracture in men and women with predialysis CKD.

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“…(4) There were 46 fractures over 40 months, and low BMD at the hip and 1/3 radius predicted fractures. There are no studies in CKD patients not yet on renal replacement therapy (RRT).…”

Section: Introductionmentioning

confidence: 94%

Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

West

Lok

Langsetmo

et al. 2014

Journal of Bone and Mineral Research

168

View full text Add to dashboard Cite

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“…Interestingly, it has been shown in a population of 2754 elderly subjects, including 587 subjects with CKD, that lower BMD was a risk factor associated with skeletal fractures 89. Several other recent papers have shown that low BMD actually predicts fracture in dialysis and renal transplant patients 90, 91. The use of micro‐computerized tomography might also be a useful tool for the estimation of bone loss and micro‐architectural changes; however, they need further evaluation in CKD 92.…”

Section: Bone and Musculoskeletal Abnormalities In Chronic Kidney Dismentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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“…Furthermore, unlike PTH, concentration of bALP directly reflects osteoblastic activity, does not accumulate in blood with declining renal function (66), and is strongly and independently related to bone mineral density (67,68). It is also a good predictor, with dual-energy x-ray absorptiometry-derived bone mineral density values, of future fracture risk in patients undergoing dialysis (69). Biologic variation of bALP is approximately half that of PTH (70).…”

Section: Pth or Alp: Combine For The Best Of Both Worldsmentioning

confidence: 99%

PTH—A Particularly Tricky Hormone

Garrett

Sardiwal

Lamb

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryPlasma parathyroid hormone (PTH) concentrations are commonly measured in the context of CKD, as PTH concentration elevation is typical in this clinical context. Much has been inferred from this raised PTH concentration tendency, both about the state of skeletal integrity and health and also about the potential clinical outcomes for patients. However, we feel that reliance on PTH concentrations alone is a dangerous substitute for the search for, and use of, more precise and reliable biomarkers. In this article, we rehearse these arguments, bringing together patient-level and analytical considerations for the first time.

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Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study

Cited by 278 publications

References 21 publications

Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

PTH—A Particularly Tricky Hormone

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