The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone

被引:21
作者
Jansz, T. T. [1 ,2 ]
Goto, N. A. [2 ,3 ]
van Ballegooijen, A. J. [4 ,5 ]
Willems, H. C. [6 ]
Verhaar, M. C. [1 ]
van Jaarsveld, B. C. [2 ,4 ]
机构
[1] Univ Utrecht, Univ Med Ctr Utrecht, Dept Hypertens & Nephrol, Utrecht, Netherlands
[2] Dianet Dialysis Ctr, Utrecht, Netherlands
[3] Univ Utrecht, Univ Med Ctr Utrecht, Dept Geriatr, Utrecht, Netherlands
[4] Vrije Univ Amsterdam, Amsterdam UMC, Dept Nephrol & Cardiovasc Sci ACS, POB 7507, NL-1007 MB Amsterdam, Netherlands
[5] Vrije Univ Amsterdam, Amsterdam UMC, Dept Epidemiol & Biostat, Amsterdam, Netherlands
[6] Univ Amsterdam, Dept Geriatr, Amsterdam UMC, Amsterdam, Netherlands
关键词
End-stage renal disease; Parathyroid hormone; Vertebral bone mineral density; Vertebral fracture; BONE-MINERAL DENSITY; HEMODIALYSIS-PATIENTS; RISK-FACTORS; BIOCHEMICAL MARKERS; DIALYSIS; WOMEN; HIP; DIAGNOSIS; OUTCOMES; CKD;
D O I
10.1007/s00198-019-05187-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk. Introduction Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture. Methods In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture. Results Mean age of the study population was 52 +/- 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13-55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (>= 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders. Conclusions The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using DXA and assessed vertebral fractures using lateral chest radiographs and not spine radiographs.
引用
收藏
页码:515 / 524
页数:10
相关论文
共 43 条
[1]   Increased risk of hip fracture among patients with end-stage renal disease [J].
Alem, AM ;
Sherrard, DJ ;
Gillen, DL ;
Weiss, NS ;
Beresford, SA ;
Heckbert, SR ;
Wong, C ;
Stehman-Breen, C .
KIDNEY INTERNATIONAL, 2000, 58 (01) :396-399
[2]   Risk factors for vertebral fractures in renal osteodystrophy [J].
Atsumi, K ;
Kushida, K ;
Yamazaki, K ;
Shimizu, S ;
Ohmura, A ;
Inoue, T .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1999, 33 (02) :287-293
[3]   Temporal Trends in Fracture Rates and Postdischarge Outcomes among Hemodialysis Patients [J].
Beaubrun, Anne C. ;
Kilpatrick, Ryan D. ;
Freburger, Janet K. ;
Bradbury, Brian D. ;
Wang, Lily ;
Brookhart, M. Alan .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2013, 24 (09) :1461-1469
[4]   Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures [J].
Black, DM ;
Cummings, SR ;
Karpf, DB ;
Cauley, JA ;
Thompson, DE ;
Nevitt, MC ;
Bauer, DC ;
Genant, HK ;
Haskell, WL ;
Marcus, R ;
Ott, SM ;
Torner, JC ;
Quandt, SA ;
Reiss, TF ;
Ensrud, KE .
LANCET, 1996, 348 (9041) :1535-1541
[5]   Low bone mineral density and fractures in stages 3-5 CKD: an updated systematic review and meta-analysis [J].
Bucur, R. C. ;
Panjwani, D. D. ;
Turner, L. ;
Rader, T. ;
West, S. L. ;
Jamal, S. A. .
OSTEOPOROSIS INTERNATIONAL, 2015, 26 (02) :449-458
[6]   Measurement of Phantomless Thoracic Bone Mineral Density on Coronary Artery Calcium CT Scans Acquired with Various CT Scanner Models [J].
Budoff, Matthew J. ;
Malpeso, Jennifer M. ;
Zeb, Irfan ;
Gao, Yanlin L. ;
Li, Dong ;
Choi, Tae-Young ;
Dailing, Christopher A. ;
Mao, Song Shou .
RADIOLOGY, 2013, 267 (03) :830-836
[7]   Trabecular Bone Mineral Density Measurement Using Thoracic and Lumbar Quantitative Computed Tomography [J].
Budoff, Matthew J. ;
Khairallah, Walid ;
Li, Dong ;
Gao, Yan Lin ;
Ismaeel, Hussain ;
Flores, Ferdinand ;
Child, Janis ;
Carson, Sivi ;
Mao, Song Shou .
ACADEMIC RADIOLOGY, 2012, 19 (02) :179-183
[8]   Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone [J].
Coco, M ;
Rush, H .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2000, 36 (06) :1115-1121
[9]   PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis [J].
Danese, MD ;
Kim, J ;
Doan, QV ;
Dylan, M ;
Griffiths, R ;
Chertow, GM .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2006, 47 (01) :149-156
[10]   Underdiagnosis of vertebral fractures is a worldwide problem: The IMPACT study [J].
Delmas, PD ;
van de Langerijt, L ;
Watts, NB ;
Eastell, R ;
Genant, H ;
Grauer, A ;
Cahall, DL .
JOURNAL OF BONE AND MINERAL RESEARCH, 2005, 20 (04) :557-563