Measures of Renal Function, BMD, Bone Loss, and Osteoporotic Fracture in Older Adults: The Rancho Bernardo Study

Abstract

ABSTRACT:The association between bone and renal function in healthy seniors is not well studied. In this cross-sectional and longitudinal study in 1713 older men and women, creatinine clearance was significantly associated with hip BMD. If confirmed, this may warrant adding mild to moderate renal dysfunction as an indication for osteoporosis screening.Introduction: This study determined the cross-sectional and longitudinal association between measures of renal function and BMD, bone loss, and osteoporotic fracture in older adults. It determined which measure of renal function-creatinine clearance by the Cockcroft-Gault (CG) equation, estimated glomerular filtration rate by the Modification of Diet in Renal Disease (MDRD) equation, or serum creatinine-is most strongly associated with BMD and osteoporotic fracture. Materials and Methods: This was a cross-sectional and prospective study in older community-dwelling men and women. Between 1992 and 1995, 1713 participants (average age, 71.3 ± 11.1 years) completed standardized questionnaires, physical examinations, laboratory testing, and bone densitometry; 1023 participants returned for a follow-up visit in 1997-1999, an average of 4.1 ± 0.9 years later. Results: Calculated renal function declined with age (p < 0.001). Renal function was categorized by Kidney Disease Outcomes Quality Initiative (K/DOQI) chronic kidney disease (CKD) stage. By the CG equation, at baseline, 5.5% of participants had stage 1 CKD (glomerular filtration rate Ն 90 ml/min/1.73 m

Comparison of laboratory and imaging methods associated with bone metabolism in patients with or without renal failure under the age of 45 years with elevated parathyroid hormone levels

“…Some studies have shown that low BMD measurements were more prevalent in patients with CKD like our findings while several other studies have reported no relationship between CKD and low BMD measurements [22][23][24][25]. In our study, except Z score at Ward's triangle, all of the T and Z scores were found statistically significantly lower in CKD patients especially T and Z scores at lumbar 3 and 4 [7,[26][27][28].…”

Efficacy and Safety of Denosumab for the Treatment of Osteoporosis in Patients with Chronic Kidney Disease

“…Nickolas et al reported an independent correlation between an eGFR <60 mL/min/1.73 m 2 and the prevalence of hip fractures [21]. In addition, elevated serum cystatin C levels have been independently associated with risk for hip fracture [22,23].…”

BMD and Fracture Risk in CKD

“…Cross-sectional studies conducted in patients both before (1-3) and after (4-8) initiation of renal replacement therapy have been inconsistent regarding the ability of DXA to discriminate between CKD patients with and without fracture. The few prospective trials assessing the fracture prediction characteristics of DXA in CKD-mineral and bone disorder (CKD-MBD) patients are also inconsistent (9)(10)(11). Moreover, the spectrum of bone turnover and mineralization abnormalities that characterize renal osteodystrophy may be associated with low, normal, or high BMD (7,12,13).…”