Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

Abstract

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.

A comparative study of bone biopsies from the iliac crest, the tibial bone, and the lumbar spine

“…One reason was that DXA cannot predict the CKD-MBD subtype. However, recent studies show that DXA can nevertheless predict fracture risk of patients with chronic kidney disease [11] and will presumably be an inherent part of the CKD-MBD diagnosis in the future.…”

Fractures in patients with CKD—diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation

“…A meta-analysis revealed that BMD is lower in predialysis and dialysis CKD patients with than in those without fractures. 39 Despite these findings, BMD measurement was not recommended in the 2009 KDIGO guidelines because of More recently, the results of 4 prospective cohort studies showed a good predictive value of BMD for the risk of fracture in CKD stages 3 to 5D, 18,26,41,52 which allows for recommending BMD measurement.…”

Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease

“…However, a recent meta-analysis reveals that BMD is significantly lower in predialysis patients with fracture compared to those without [31]. A prospective study has shown that BMD measured by dual X-ray absorptiometry (DXA) predicts incident fracture in stages 3–5 CKD patients, and the prediction ability is comparable to that using high-resolution peripheral quantitative computed tomography [32]. Furthermore, two studies have reported the assessment of BMD using DXA to predict fractures in CKD patients including those on hemodialysis [33, 34].…”