The utility of FRAX® in predicting bone fractures in patients with chronic kidney disease on hemodialysis: a two-year prospective multicenter cohort study

Przedlacki, J; Buczyńska-Chyl, Jolanta; Kozminski, Piotr; Niemczyk, Stanisław; Wojtaszek, Ewa; Gieglis, Edyta; Żebrowski, Paweł; Podgórzak, Andrzej; Wściślak, J; Wieliczko, Monika; Matuszkiewicz‐Rowińska, Joanna

doi:10.1007/s00198-018-4406-z

Cited by 28 publications

(14 citation statements)

References 36 publications

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“…Nutrients are directly linked to spine, hip and whole-body bone density in postmenopausal women [ 22 ] and patients on hemodialysis [ 23 , 24 ]. In contrast to previous study, a shorter duration of hemodialysis was inversely associated with vertebral fracture in this study [ 7 , 25 ]. Despite these observations, the duration of hemodialysis has not been consistently correlated with fracture.…”

Section: Discussioncontrasting

confidence: 99%

Prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease

Jirasirirak

Disthabanchong

Ongphiphadhanakul

et al. 2022

Heliyon

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Section: Discussioncontrasting

confidence: 99%

Prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease

Jirasirirak

Disthabanchong

Ongphiphadhanakul

et al. 2022

Heliyon

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“…e factors that influenced the higher FN BMD during CKD progression but did not influence LS BMD remain unclear. is result may be explained by the fact that the hip has more cortical bone than, which is more impaired compared to, trabecular of the bone in CKD patients [59][60][61].…”

Section: Discussionmentioning

confidence: 99%

Association between Bone Mineral Density and Severity of Chronic Kidney Disease

Huang

Zheng

Sun

et al. 2020

International Journal of Endocrinology

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Objective. We sought to evaluate the association between femoral neck (FN) and lumbar spine (LS) bone mineral densities (BMDs) with severity of chronic kidney disease (CKD) and prevalence of osteopenia or osteoporosis (OP) among the CKD group. Methods. Cross-sectional data from 11050 participants aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) were analyzed. Specifically, Pearson correlation was applied to analyze the relationship between BMD and estimated glomerular filtration rate (eGFR). General linear models (GLMs) were adjusted for potential confounders and used to analyze mean BMD, based on CKD and CKD stages. Results. FN BMD was positively correlated with the eGFR in the total and male CKD, but not in the female CKD population. LS BMD was not significantly associated with eGFR. After controlling for partial correlations, FN T-score was positively correlated with the eGFR in the total at-risk population. According to FN BMD, OP prevalence was positively associated with CKD stage. However, according to LS BMD, there was no significant association between OP and CKD stage. Conclusion. Our results may explain the higher prevalence of hip fracture, relative to that of the spine, among CKD patients and generate meaningful insights to guide care, prevention, and treatment regimens for CKD patients. However, the fact that this was a cross-sectional study may limit the possibility of drawing concrete conclusions. Nevertheless, these findings open up a new frontier for further studies to uncover the higher decrease of FN BMD compared to LS BMD among CKD cases.

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“…17 In patients with CKD, a recent study had reported that FRAX discriminated and predicted fractures. 21 However, whether the combination of clinical risk factors with BMD improves predictive discrimination is not clear. 22,23 Therefore, we tested whether combining a subset of the clinical risk factors in FRAX (age, sex, race, weight, height, family history of fracture, glucocorticoid use, and smoking history) with BMD at the total hip would improve fracture prediction.…”

Section: Discussionmentioning

confidence: 99%

Association of Bone Mineral Density With Fractures Across the Spectrum of Chronic Kidney Disease: The Regina CKD-MBD Study

Prasad

Ferguson

Tangri

et al. 2019

Can J Kidney Health Dis

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Background: Recent studies have demonstrated that measurement of areal bone mineral density by dual-energy x-ray absorptiometry (DXA) predicts fractures in patients with chronic kidney disease (CKD). However, whether fracture risk prediction through bone mineral density (BMD) is enhanced due to the assessment of biochemical markers of chronic kidney disease and mineral and bone disease (CKD-MBD) or clinical risk factors is not clear. We hypothesized that in a select cohort of patients managed in a CKD clinic, that combining T-Scores with biochemical markers would optimize fracture discrimination than using DXA alone. Objective: To examine the relationships among BMD, biochemical markers of CKD-MBD, and fracture risk across Kidney Disease Improving Global Outcomes (KDIGO) glomerular filtration rate (GFR) categories G3a to G5. Design: Retrospective study. Setting: Patients were recruited from the multidisciplinary CKD clinic, Regina General Hospital, Canada. Patients: A total of 374 patients who received a DXA scan upon initial referral to Regina Multidisciplinary CKD Program from January 31, 2001 to January 31, 2010, were included in this study. The patients were followed for a total of 5 years. Methods: We conducted a retrospective review of 374 consecutive patients who underwent DXA imaging at the point of entry into our multidisciplinary CKD program. Areal BMD, T- and Z-Scores were obtained at the lumbar spine, total hip, mean of left and right femoral neck, and the one-third radius. We collected data on demographic, cross-sectional biochemical markers of mineral metabolism and fractures (identified through self-reported questionnaires, hospital electronic medical records, and physician billing records). We were able to gather data on 8/11 variables of Fracture Risk Assessment (FRAX) tool. Results: In our cohort, 14.3% of GFR categories G3a and G3b, 15.7% of GFR category G4, and 19.7% of GFR category G5 experienced a clinical fracture during the study period. On multivariate analysis, each decline of 1.0 SD in total hip BMD T-Score was associated with a significant increase in the risk of fracture (OR = 1.46, 95% confidence interval [CI], 1.12-1.89). Adding CKD-MBD markers and clinical risk factors did not further contribute to the model. Low BMD was the only independent risk factor for fracture in patients with CKD. Limitations: Self-reporting by patients and administrative records were used to identify fractures. We did not perform spine imaging to ascertain morphometric vertebral fractures. We were unable to gather all 11 variables of FRAX score and information on ethnicity. We were unable to capture site of fracture (hips, spine, etc) from billing records. Albumin excretion rates were not collected at baseline. Treatment of the underlying bone disease with pharmacotherapeutic agents may have attenuated patients’ fracture risk and thus underestimated the association between BMD and future fracture. Conclusions: Our findings confirm that BMD predicts fracture. The addition of cross-sectional CKD-MBD parameters and clinical risk factors to BMD did not add to fracture prediction. Prospective studies should investigate the utility of longitudinal biochemical markers on improving fracture risk assessment.

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The utility of FRAX® in predicting bone fractures in patients with chronic kidney disease on hemodialysis: a two-year prospective multicenter cohort study

Abstract: FRAX® enables a better assessment of major bone fracture risk in ESRD patients undergoing hemodialysis than any of its components and other risk factors considered in the analysis.

Cited by 28 publications

References 36 publications

Prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease

Prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease

Association between Bone Mineral Density and Severity of Chronic Kidney Disease

Association of Bone Mineral Density With Fractures Across the Spectrum of Chronic Kidney Disease: The Regina CKD-MBD Study

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