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BMC Nephrology
Published in: BMC Nephrology 1/2019

Open Access 01-12-2019 | Testosterone | Research article

Differences in association of lower bone mineral density with higher coronary calcification in female and male end-stage renal disease patients

Authors: Zhimin Chen, Abdul Rashid Qureshi, Torkel B. Brismar, Jonaz Ripsweden, Mathias Haarhaus, Peter Barany, Olof Heimburger, Bengt Lindholm, Peter Stenvinkel

Published in: BMC Nephrology | Issue 1/2019

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Abstract

Background

Risk of cardiac events and cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients are predicted by coronary artery calcification (CAC) independently. It is not clear to what extent low bone mineral density (BMD) is associated with higher risk of CAC and if sex interacts. We investigated the sex-specific associations of CAC score with total body BMD (tBMD) as well as with BMD of different skeletal sub-regions.

Methods

In 174 ESRD patients, median age 57 (10th–90th percentiles 29–75) years, 63% males, BMD (measured by dual-energy X-ray absorptiometry; DXA), CAC score (measured by cardiac CT) and circulating inflammatory biomarkers were analysed.

Results

A total of 104 (60%) patients with CAC > 100 AUs were older, had higher prevalence of both clinical CVD and diabetes, higher level of high sensitivity C-reactive protein, tumour necrosis factor, interleukin-6 and lower T-score of tBMD. Female patients had significantly lower tBMD and BMD of all skeletal sub-regions, except head, than male patients. Female patients with high CAC (> 100 AUs) had significantly decreased T-score of tBMD, and lower BMD of arms, legs than those low CAC (≤ 100 AUs); elevated CAC score were associated with tBMD, T-score, Z-score of tBMD and BMD of arms and legs, while no such differences was observed in males. Multivariate generalized linear model (GLM) analysis adjusted for age, diabetes and hsCRP showed that in females per SD higher CAC score (1057 AUs) was predicted by either per SD (0.13 g/cm2) lower tBMD or per SD (0.17 g/cm2) lower BMD at legs. No such associations were found in male ESRD patients.

Conclusions

In female, but not male, lower BMD, in particular sub-regions of legs, was associated with higher CAC score independently. Low BMD has the potential to identify increased risk for high CAC score in ESRD patients.
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Metadata
Title
Differences in association of lower bone mineral density with higher coronary calcification in female and male end-stage renal disease patients
Authors
Zhimin Chen
Abdul Rashid Qureshi
Torkel B. Brismar
Jonaz Ripsweden
Mathias Haarhaus
Peter Barany
Olof Heimburger
Bengt Lindholm
Peter Stenvinkel
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Testosterone
Published in
BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-019-1235-z

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