The Efficacy of Low-intensity Vibration to Improve Bone Health in Patients with End-stage Renal Disease Is Highly Dependent on Compliance and Muscle Response

Abstract

Rational and Objectives Low intensity vibration (LIV) may represent a nondrug strategy to mitigate bone deficits in patients with end-stage renal disease. Materials and Methods Thirty end-stage renal patients on maintenance hemodialysis were randomized to stand for 20 minutes each day on either an active or placebo LIV device. Analysis at baseline and completion of 6-month intervention included magnetic resonance imaging (tibia and fibula stiffness; trabecular thickness, number, separation, bone volume fraction, plate-to-rod ratio; and cortical bone porosity), dual-energy X-ray absorptiometry (hip and spine bone mineral density [BMD]), and peripheral quantitative computed tomography (tibia trabecular and cortical BMD; calf muscle cross-sectional area). Results Intention-to-treat analysis did not show any significant changes in outcomes associated with LIV. Subjects using the active device and with greater than the median adherence (70%) demonstrated an increase in distal tibia stiffness (5.3%), trabecular number (1.7%), BMD (2.3%), and plate-to-rod ratio (6.5%), and a decrease in trabecular separation (−1.8%). Changes in calf muscle cross-sectional area were associated with changes in distal tibia stiffness (R = 0.85), trabecular bone volume/total volume (R = 0.91), number (R = 0.92), and separation (R = −0.94) in the active group but not in the placebo group. Baseline parathyroid hormone levels were positively associated with increased cortical bone porosity over the 6-month study period in the placebo group (R = 0.55) but not in the active group (R = 0.01). No changes were observed in the nondistal tibia locations for either group except a decrease in hip BMD in the placebo group (−1.7%). Conclusion Outcomes and adherence thresholds identified from this pilot study could guide future longitudinal studies involving vibration therapy.

Cortical or Trabecular Bone: What’s the Difference?

“…Low intensity vibration in patients with chronic kidney disease increases strength parameters of the tibia due to changes in the trabecular compartment but not the cortex [4]. …”

High Levels of Physical Activity May Promote a Reduction in Bone Mineral Density in Peritoneal Dialysis

“…The low level of physical activity among these patients, specifically the low level of moderate/vigorous physical activity, can even induce a decrease in BMD as a consequence of disuse, so the present results of the present study may be influenced by the fact that the women registered longer times of moderate/vigorous activity and lower values of BMD than did men. In fact, renal osteodystrophy is a multifactorial and pervasive disorder of bone and mineral metabolism that is present in individuals with CKD [38]. This disorder leads to a decrease in BMD and increases the risk of bone fracture [39].…”

Whole body vibration to attenuate reduction of explosive force in chronic kidney disease patients: a randomized controlled trial

“…Data regarding the effects of WBV training in CKD patients are scarce. Recent pilot studies indicated that WBV training has the potential to attenuate bone deficits and improve physical function in this population ( Doyle et al, 2017 ; Rajapakse et al, 2017 ). Our results may be of great clinical importance in the treatment of people with CKD.…”