Prevalence and Risk Factors of Osteoporosis in Saudi End-Stage Renal Disease Patients on Hemodialysis

Abstract

Background: Osteoporosis is characterized by a decrease in bone mineral density, thereby increasing the risk of pathological fractures. It is a common complication of chronic kidney disease. However, there is limited local data on the prevalence of osteoporosis in end-stage renal disease. Objective: The current study evaluated the epidemiology of osteoporosis in end-stage rental disease patients at a Saudi Arabian tertiary care center. Methods: This cross-sectional retrospective study was conducted using data obtained between 1 January 2016 and 31 December 2019 at the Dialysis Center at King Abdulaziz Medical City, Riyadh, Saudi Arabia. End-stage rental disease patients who were aged ≥50 years and underwent hemodialysis for at least 1 year were included, while those with documented metabolic bone disease and absence of bone mineral density data were excluded. Results: Sixty-four end-stage rental disease patients undergoing hemodialysis met the inclusion criteria. The patients underwent bone mineral density measurement at the discretion of the treating physician. The mean patients' age was 73 ± 11.5 years and 76% were women. The overall prevalence of osteoporosis was 37.5%, and it was similarly distributed among women and men (38.8% and 33.3%, respectively). Nine of the 15 male patients (60%) and 24 of the 49 female patients (49%) had fractures. Twenty-five (39%) patients used glucocorticoids. Osteoporosis was most commonly identified in the femoral neck (26.2%), followed by proximal femur (19.4%), and lumbar spine (18.8%). A high rate of osteoporosis was significantly associated with older age and being underweight. Conclusion: A high rate of low bone mineral density was demonstrated in end-stage renal disease patients. The femoral neck was the most common osteoporosis site in this patient population, and advanced age and underweight were possible risk factors for low bone mass.

Effects of denosumab on bone mineral density and bone metabolism in patients with end‐stage renal disease: A systematic review and meta‐analysis

“…7 Patients with end-stage renal disease (ESRD) on maintenance dialysis (CKD G5D) are at an increased risk of fracture, given their suboptimal bone quantity and quality. [8][9][10][11] The incidence of non-vertebral fractures in patients with osteoporosis is higher than that in control individual matched by age and sex. 12,13 Denosumab is an inhibitor of receptor activator of nuclear factor kappa-B ligand (RANKL) which plays an important role in osteoclast formation, function, and survival.…”

“…With the progression of CKD, the risks of osteoporosis and fragility‐related fractures increase 7 . Patients with end‐stage renal disease (ESRD) on maintenance dialysis (CKD G5D) are at an increased risk of fracture, given their suboptimal bone quantity and quality 8–11 . The incidence of non‐vertebral fractures in patients with osteoporosis is higher than that in control individual matched by age and sex 12,13 …”

Osteoporosis Risk in Hemodialysis Patients: The Roles of Gender, Comorbidities, Biochemical Parameters, Health and Diet Literacy

“…There are many factors that may contribute to an increased osteoporosis risk in chronic kidney patients, including abnormal biochemical markers (e.g., calcium, phosphorus, vitamin D, and parathyroid hormone), inflammatory cytokines status, sarcopenia, corticoid use, and lifestyle [ 10 , 11 , 12 , 13 ]. Factors that are associated with osteoporosis in pre-dialysis or hemodialysis patients have been found in previous studies, e.g., being female, being of an older age, and having a low body mass index [ 7 , 14 , 15 ]. Abdominal obesity was found to be a preventable factor for osteoporosis risk in hemodialysis patients [ 16 ].…”