Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis

Ambrus, C M; Almasi, Cs.; Berta, Klára; Deák, Gy.; Márton, Adrienn; Molnar, Miklos Z.; Nemeth, Zs.; Horvath, C; Lakatos, Péter; Szathmári, Miklós; Mucsi, István

doi:10.1007/s11255-010-9723-x

Cited by 69 publications

(59 citation statements)

References 29 publications

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“…Vitamin D deficiency is a risk factor for fracture. 37,38 However, our results did not detect any relationship between 25OHD and fracture risk, possibly because of equivalent vitamin D supplementation in each group. Furthermore, most subjects had an eGFR Ͻ 45 ml/min, a level at which serum 25OHD weakly correlates with hyperparathyroidism.…”

Section: Clinical Research Wwwjasnorgcontrasting

confidence: 61%

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Nickolas

Cremers²,

Zhang³

et al. 2011

Journal of the American Society of Nephrology

125

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Patients with chronic kidney disease (CKD) have higher rates of fracture than the general population. Increased bone remodeling, leading to microarchitectural deterioration and increased fragility, may accompany declining kidney function, but there are no reliable methods to identify patients at increased risk for fracture. In this cross-sectional study of 82 patients with predialysis CKD, high-resolution imaging revealed that the 23 patients with current fractures had significantly lower areal density at the femoral neck; total, cortical, and trabecular volumetric bone density; cortical area and thickness; and trabecular thickness. Compared with levels in the lowest tertile, higher levels of osteocalcin, procollagen type-1 N-terminal propeptide, and tartrate-resistant acid phosphatase 5b were associated with higher odds of fracture, even after adjustment for femoral neck T-score. Discrimination of fracture prevalence was best with a femoral neck T-score of Ϫ2.0 or less and a value in the upper two tertiles for osteocalcin, procollagen type-1 N-terminal propeptide, or tartrate-resistant acid phosphatase 5b; these values corresponded to the upper half of the normal premenopausal reference range. In summary, these cross-sectional data suggest that measurement of bone turnover markers may increase the diagnostic accuracy of densitometry to identify patients with CKD at high risk for fracture.

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Section: Clinical Research Wwwjasnorgcontrasting

confidence: 61%

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Nickolas

Cremers²,

Zhang³

et al. 2011

Journal of the American Society of Nephrology

125

View full text Add to dashboard Cite

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“…An observational study of 104 dialysis patients who underwent a trans‐iliac bone biopsy showed that patients with vitamin D insufficiency [25(OH)D ≤ 15 ng/mL] had lower trabecular mineralization surface and bone formation rate regardless of levels of 1,25(OH) 2 D and PTH 116. Other studies have shown that CKD patients with low circulating 25(OH)D have an increased risk of reduced BMD and of skeletal fractures,117, 118, 119 as well as of radiologic features of secondary hyperparathyroidism 120. In contrast, a more recent study that included 59 dialysis patients did not show significant differences in T‐scores and trabecular bone scores among patients according to their 25(OH)D levels 121.…”

Section: Vitamin D Status In Chronic Kidney Disease: Data From Observmentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

102

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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“…Ambrus et al retrospectively examined the association between fracture and vitamin D status in 130 patients on maintenance hemodialysis. 24 Patients with fractures had significantly lower 25(OH) vitamin D levels compared with patients without fractures and lower vitamin D levels were independently associated with increased fracture risk in a multivariable analysis (OR 11.22, 95% confidence interval 1.33-94.82). The same investigators also described low 25 (OH) vitamin D levels associated with reduced bone mineral bone density in maintenance hemodialysis patients.…”

Section: Prevalence Of Vitamin D Deficiency In Ckdmentioning

confidence: 88%

“…21,22 Factors related to CKD-MBD including elevated PTH, vitamin D deficiency, bone remodeling, increased bone fragility and micro-structural deterioration along with increased fall risk are reported to explain this increased fracture risk in ESRD patients. 23,24 As well described in the literature, CKD is characterized by low 25(OH) vitamin D (calcidiol), low 1,25(OH) 2 vitamin D (calcitriol) as well as vitamin D resistance. 25,26 Key mechanisms for these changes are summarized in Table 2.…”

Section: Ckd-mbd: Pathogenesis and Role Of Vitamin Dmentioning

confidence: 94%

Vitamin D and chronic kidney disease–mineral bone disease (CKD–MBD)

2014

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Chronic kidney disease (CKD) is a modern day epidemic and has significant morbidity and mortality implications. Mineral and bone disorders are common in CKD and are now collectively referred to as CKD-mineral and bone disorder (MBD). These abnormalities begin to appear even in early stages of CKD and contribute to the pathogenesis of renal osteodystrophy. Alteration in vitamin D metabolism is one of the key features of CKD-MBD that has major clinical and research implications. This review focuses on biology, epidemiology and management aspects of these alterations in vitamin D metabolism as they relate to skeletal aspects of CKD-MBD in adult humans.

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Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis

Cited by 69 publications

References 29 publications

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Vitamin D and chronic kidney disease–mineral bone disease (CKD–MBD)

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