Femoral Neck Fractures in Patients Receiving Long-Term Dialysis

Schaab, Peter C.; Murphy, Gayle; Tzamaloukas, Antonios H.; Hays, Marvin B.; Merlin, Toby L.; Eisenberg, Brian; Avasthi, Pratap S.; Worrell, Richard V.

doi:10.1097/00003086-199011000-00038

Cited by 39 publications

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“…In the past, intensive use of aluminum-containing phosphate binders have been associated with aluminium overload and increased incidence of bone fractures [13]. But even after aluminum overload problem in dialysis patients has been solved through the use of calcium salts, sevelamer, and other newer phosphate binders in recent years, some studies still have been reporting increased bone fracture prevalence in ESRD patient groups [14][15][16]. These studies have reported an increased prevalence of fractures; the risk for hip fracture is increased 3-to 4-fold in patients with ESRD [14].…”

Section: Definition and Importance Of Osteoporosis In The Elderly Diamentioning

confidence: 99%

Osteoporosis in the elderly with chronic kidney disease

Ersoy

2006

Int Urol Nephrol

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Considering the aging dialysis population of today, increasing our knowledge about the nature, diagnosis and the treatment of bone mineral density (BMD) problems in end-stage renal disease (ESRD) patients deserves more attention. Osteoporosis is basicly defined as a decrease in bone mass. Large epidemiological studies in general population have identified several risk factors for osteoporosis including advancing age, female gender, white race, decreased calcium intake, gastric acid suppression therapy, sedentary lifestyle, premature loss of gonadal function, decreased estrogen secretion, thin body habitus, decreased physical activity, cigarette smoking, alcohol abuse, excess glucocorticoid exposure, and possibly some genetic factors. Osteoporosis in ESRD patients is only a part of a wider spectrum of metabolic bone problems, namely uremic osteodystrophy. Therefore, its diagnosis, management and follow-up may differ from the general population and an individualization of diagnosis and definition for dialysis population may be necessary. However, standard diagnostic tools such as dual energy X-ray absorptiometry (DEXA) have been widely used for the assessment of bone mineral deficiency status in ESRD patients. Regardless of the methods, most of the studies are in concordance with a reduced BMD in HD and PD patients. Dialysis patients are known to be at increased risk for low-trauma fractures. Thinning of cortical bone, which is responsible for the largest contribution toward reduced bone mineral content in chronic renal failure results in increased fracture risk. In either normal population and dialysis patients, fracture risk is increased with age. But in dialysis patients, besides age, several other factors may also affect the degree of bone mineral deficiency, and age-BMD relationship may be blunted. Female sex, in hemodialysis patients is negatively associated with total hip BMD. While several studies have been unable to demonstrate any association between BMD and PTH levels, larger body size has been shown to have a significant positive effect on BMD in both hemodialysis and peritoneal dialysis patients. Although they have been used in small groups of chronic kidney disease (CKD) and ESRD patients, because of their potential nephrotoxicity and hypocalcemic effects, use of biphosphonates in renal patients is questionable. Currently, bone biopsy, in order to exclude adynamic bone disease is recommended before beginning treatment with bisphosphonates in chronic kidney disease and dialysis patients.

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Section: Definition and Importance Of Osteoporosis In The Elderly Diamentioning

confidence: 99%

Osteoporosis in the elderly with chronic kidney disease

Ersoy

2006

Int Urol Nephrol

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“…Several series of hip fractures in dialysis patients have been reported, 79 , 86 but there has been only one comprehensive epidemiologic study. Based on hospital discharge codes, hip fracture risk is increased 3‐ to 4‐fold in patients with end‐stage renal disease, regardless of gender or race 87 .…”

Section: Mineralized Bone Loss and Fracture Risk In Renal Bone Diseasementioning

confidence: 99%

A Structural Approach to Renal Bone Disease

Parfitt

1998

Journal of Bone and Mineral Research

154

139

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W HILE NO ONE WOULD DENY that there has been great progress made in our understanding of metabolic bone disease and our ability to evaluate these disorders in affected subjects, the accompanying editorial by Dr. Michael Parfitt provides undeniable evidence that we must recognize that progress has mixed benefits. Indeed, he points out what we have lost by reducing the use of bone biopsy and standard radiographies while relying on dual-energy X-ray absorptiometry of the central skeleton. His insights are extraordinarily relevant to the clinical decision making in patients with the bone abnormalities typically encountered in chronic renal failure.Clearly this article is essential reading for nephrologists, endocrinologists, rheumatologists, orthopedists, and bone basic scientists. Moreover, insights provided are a tribute to the gifted perspective that Dr. Parfitt brings to the bone and mineral community.

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“…Patients with endstage renal disease develop renal osteodystrophy from various causes, including hyperparathyroidism [2,3], adynamic bone disease [4,5] and aluminum bone toxicity [6][7][8][9][10][11]. Since increasing morbidity and mortality were noted in the HD patients with nonoperated hip fractures [1,12], it is important to discriminate HD patients with a high risk of hip fractures so that precautions can be taken to prevent them. The risk for osteopenia in renal osteodystrophy is caused by secondary hyperparathyroidism, 1,25-dihydroxyvitamin D deficiency, previous immunosuppression therapy, chronic acidosis, secondary amenorrhea and chronic aluminum and heparin exposure [13].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Hip Fracture in Hemodialysis Patients

et al. 2002

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Background: The incidence and mortality of hip fractures were several times greater in the patients with hemodialysis (HD) than in the general population. Although patients with end-stage renal disease develop renal osteodystrophy, few published data examined the risk factor of hip fractures in the dialysis population. Methods: The present study was performed to compare various indices and bone mineral density (BMD) of HD patients with or without the history of hip fractures. Moreover, we analyzed the factors which predicted hip fractures in 183 patients with chronic HD enrolled in the cross-sectional study. Results: Serum level of alkaline phosphatase was significantly higher in HD patients with hip fractures, compared to those without hip fractures. Oral calcium carbonate dose was significantly lower in HD patients with hip fractures. 1/3 radius (R)-BMD and ultradistal (UD)R-BMD were significantly lower in HD patients with hip fractures. However, lumbar spine (LS)-BMD was comparable in HD patients with or without hip fractures. Although there was no significant differences of BMD between with and without hip fractures in diabetes mellitus, UDR-BMD of patients with hip fractures was significantly lower than that of patients without hip fractures in chronic glomerulonephritis. Radial BMD was lower in female patients with hip fractures, compared to without hip fractures, although there were no significant differences in male patients. In multiple logistic regression analysis, oral calcitriol dose and 1/3R-BMD were selected as a risk factor of hip fractures in HD patients. Conclusion: Radial BMD was lower in HD patients with hip fractures. However, its contribution is different, depending on gender and the original disease leading to HD. Radial BMD and oral calcitriol dose seemed to be important to predict the risk of hip fractures.

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Femoral Neck Fractures in Patients Receiving Long-Term Dialysis

Cited by 39 publications

References 0 publications

Osteoporosis in the elderly with chronic kidney disease

Osteoporosis in the elderly with chronic kidney disease

A Structural Approach to Renal Bone Disease

Risk Factors for Hip Fracture in Hemodialysis Patients

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