Femoral Neck X-Ray Absorptiometry Parameters and Peripheral Quantitative Computer Tomography Tibial Cortical Density Predict Survival in Dialysis Patients

Yap, Natalie; Wong, Phillip; McGinn, Stella; Nery, Maria Liza; Doyle, Jean; Wells, L. D.; Clifton‐Bligh, P.; Clifton‐Bligh, Roderick

doi:10.1159/000460262

Cited by 3 publications

(5 citation statements)

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“…This observation may indicate a stronger correlation with cortical bone-rich areas [ 32 ]. Additionally, cortical bone has also been linked to mortality, as evidenced by a five-year follow-up study in HD patients, which demonstrated that low BMD at the hip predicted mortality [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Bone mineral density and related clinical and laboratory factors in peritoneal dialysis patients: Implications for bone health management

Tamimi,

Bdair,

Shratih

et al. 2024

PLoS ONE

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Background End-stage renal disease (ESRD) patients often experience accelerated bone turnover, leading to osteoporosis and osteopenia. This study aimed to determine the prevalence of osteoporosis in Peritoneal Dialysis (PD) patients using bone mineral density (BMD) measurements obtained through dual-energy X-ray absorptiometry (DEXA) scan and to explore any possible associations with clinical and biochemical factors. Methods In this cross-sectional study, we enrolled 76 peritoneal dialysis patients from the dialysis center at An-Najah National University Hospital in Nablus, Palestine. We used the DEXA scan to measure BMD at the lumbar spine and hip, with values expressed as T-scores. We conducted a multivariate analysis to explore the relationship between BMD and clinical and biochemical parameters. Results Over half (52.6%) of the PD patients had osteoporosis, with a higher prevalence observed among patients with lower BMI (p<0.001). Higher alkaline phosphatase levels were found among osteoporotic patients compared to non-osteoporotic patients (p = 0.045). Vitamin D deficiency was also prevalent in this population, affecting 86.6% of patients. No significant correlation was found between 25 vitamin D levels and BMD. No significant correlation was found between Parathyroid hormone (PTH) levels and BMD. Conclusion A notable proportion of PD patients experience reduced BMD. Our study found no correlation between vitamin D levels and BMD, but it highlighted the significant vitamin D deficiency in this population. Furthermore, our analysis indicated a positive correlation between BMI and BMD, especially in the femoral neck area. This underscores the significance of addressing bone health in PD patients to mitigate the risk of fractures and improve their overall well-being.

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Section: Discussionmentioning

confidence: 99%

Bone mineral density and related clinical and laboratory factors in peritoneal dialysis patients: Implications for bone health management

Tamimi,

Bdair,

Shratih

et al. 2024

PLoS ONE

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“…Compared with the general population where there is an abundance of data, the relationship between BMD and CVD mortality in ESRD is less clear due to the relatively small number of patients and publications in this field. Most previous reports regarding ESRD patients analysed the association between BMD and all-cause mortality, while only a few studies investigated the relationship between BMD and CVD mortality in ESRD patients [ 6 , 7 , 17–20 , 66 , 67 ] ( Table 1 ).…”

Section: Low Bmd Predicts Increased All-cause and Cvd Mortalitymentioning

confidence: 99%

“…Furthermore, another study reported that forearm sites in addition to femoral neck were associated with high all-cause mortality in univariate analysis [ 19 ]. Yap et al [ 67 ] used pQCT in addition to DXA in a prospective study of 58 dialysis patients with 6 years follow-up and found that tibia cortical density by pQCT, in addition to BMD at femoral neck measured by DXA, was significantly associated with increased all-cause mortality.…”

Section: Low Bmd Predicts Increased All-cause and Cvd Mortalitymentioning

confidence: 99%

Bone mineral density and mortality in end-stage renal disease patients

Iseri

Dai

Chen

et al. 2020

Clinical Kidney Journal

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Osteoporosis characterized by low bone mineral density (BMD) as assessed by dual-energy X-ray absorptiometry (DXA) is common among end-stage renal disease (ESRD) patients and associates with high fracture incidence and high all-cause mortality. This is because chronic kidney disease-mineral bone disorders (CKD-MBDs) promote not only bone disease (osteoporosis and renal dystrophy) but also vascular calcification and cardiovascular disease. The disturbed bone metabolism in ESRD leads to ‘loss of cortical bone’ with increased cortical porosity and thinning of cortical bone rather than to loss of trabecular bone. Low BMD, especially at cortical-rich bone sites, is closely linked to CKD-MBD, vascular calcification and poor cardiovascular outcomes. These effects appear to be largely mediated by shared mechanistic pathways via the ‘bone–vascular axis’ through which impaired bone status associates with changes in the vascular wall. Thus, bone is more than just the scaffolding that holds the body together and protects organs from external forces but is—in addition to its physical supportive function—also an active endocrine organ that interacts with the vasculature by paracrine and endocrine factors through pathways including Wnt signalling, osteoprotegerin (OPG)/receptor activator of nuclear factor-κB (RANK)/RANK ligand system and the Galectin-3/receptor of advanced glycation end products axis. The insight that osteogenesis and vascular calcification share many similarities—and the knowledge that vascular calcification is a cell-mediated active rather than a passive mineralization process—suggest that low BMD and vascular calcification (‘vascular ossification’) to a large extent represent two sides of the same coin. Here, we briefly review changes of BMD in ESRD as observed using different DXA methods (central and whole-body DXA) at different bone sites for BMD measurements, and summarize recent knowledge regarding the relationships between ‘low BMD’ and ‘fracture incidence, vascular calcification and increased mortality’ in ESRD patients, as well as potential ‘molecular mechanisms’ underlying these associations.

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“…Finally, 12 studies were included in the review and meta-analysis. (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) Details of the literature search process are shown in Fig. 1.…”

Section: Characteristics Of Eligible Cohort Studiesmentioning

confidence: 99%

“…(14,16,17) The relationship between BMD at different sites and mortality risk is controversial in CKD patients. (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) Moreover, there are still no unique recommendations on the optimal sites for interpretation of bone loss and monitoring the prognosis of CKD patients. Thus, we aimed at conducting a systematic review and metaanalysis of cohort studies to evaluate the association of BMD at various bone sites with all-cause mortality in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

Bone Mineral Density Is Inversely Associated With Mortality in Chronic Kidney Disease Patients: A Meta-Analysis

Jiang

Yan

Duan

2020

Journal of Bone and Mineral Research

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Low bone mineral density (BMD) is suggested to be associated with increased mortality in the general health population, but the relationship in chronic kidney disease (CKD) patients is still unclear. We performed a meta‐analysis to investigate the association of BMD in different sites with risk of all‐cause mortality in CKD patients. We searched PubMed, EMBASE, and Web of Science to identify eligible cohort studies that evaluated the association between BMD at different sites and risk of all‐cause mortality in CKD patients. Twelve cohort studies were identified, which included 2828 CKD patients and 1052 deaths. Compared with normal/high level of total body BMD, lower total body BMD was associated with 25% higher risk of all‐cause mortality. The pooled relative risk (RR) was 1.25 (95% confidence interval [CI] 1.09, 1.42) with little heterogeneity across studies. Regarding BMD measured at different sites, the risk of all‐cause mortality was highest for lower BMD at hip/femoral neck (pooled RR = 1.69; 95% CI 1.20, 2.40). The pooled RRs were 1.26 (95% CI 1.04, 1.53) and 1.17 (95% CI 1.00, 1.37) for lower BMD at arm and spine, respectively. Similarly, the risk of death for per SD decrease in BMD was also higher at hip/femoral neck (pooled RR = 1.43, 95% CI 1.15, 1.77) compared with arm (pooled RR = 1.03, 95% CI 1.00, 1.06) and spine (pooled RR = 1.17, 95% CI 0.98, 1.39). In conclusion, lower BMD values at hip, arm, spine, as well as the whole body are associated with increased risk of all‐cause mortality in CKD patients. The excess risk is highest for patients with lower BMD at hip/femoral neck, suggesting BMD measured at hip region may be the best indicator of mortality risk in CKD patients. © 2022 American Society for Bone and Mineral Research (ASBMR).

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Femoral Neck X-Ray Absorptiometry Parameters and Peripheral Quantitative Computer Tomography Tibial Cortical Density Predict Survival in Dialysis Patients

Cited by 3 publications

References 57 publications

Bone mineral density and related clinical and laboratory factors in peritoneal dialysis patients: Implications for bone health management

Bone mineral density and related clinical and laboratory factors in peritoneal dialysis patients: Implications for bone health management

Bone mineral density and mortality in end-stage renal disease patients

Bone Mineral Density Is Inversely Associated With Mortality in Chronic Kidney Disease Patients: A Meta-Analysis

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