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International Urology and Nephrology
Published in: International Urology and Nephrology 2/2011

01-06-2011 | Nephrology – Original Paper

Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis

Authors: Cs. Ambrus, Cs. Almasi, K. Berta, Gy. Deak, A. Marton, M. Zs. Molnar, Zs. Nemeth, Cs. Horvath, P. Lakatos, M. Szathmari, I. Mucsi

Published in: International Urology and Nephrology | Issue 2/2011

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Abstract

Background

The incidence of fractures is substantially increased in patients with chronic kidney disease (CKD) compared to the general population. The factors associated with increased bone fracture in this population are not well understood. Vitamin D deficiency has been associated with decreased bone mass and higher incidence of fractures in the general population. In this study, we aimed to assess the association between fracture and vitamin D status and other factors potentially associated with fracture in patients on maintenance hemodialysis.

Methods

One hundred and forty-four patients were assessed and interviewed about previous low-trauma fractures. Evidence of fracture was obtained from medical records and also through patient interviews. Routine laboratory results were collected from medical records. Serum intact PTH (iPTH) and 25(OH) vitamin D3 were measured. All patients underwent bone densitometry of the lumbar spine, femoral neck and distal radius. Bone quality was also assessed with quantitative bone ultrasound (QUS). Descriptive statistics, logistic regression models were used to analyze factors associated with fractures.

Results

One hundred and thirty patients were included in the final analysis. Patients with fractures (n = 21) had lower 25(OH) vitamin D3 levels (15.8 nmol/l (interquartile range, IQR: 27) vs. 30.0 nmol/l (IQR: 28.5), P = 0.029), were more likely females, had longer duration of end-stage kidney disease, and lower bone mineral density (BMD) at the distal radius. QUS parameters were not associated with fractures. Multivariate analyses revealed that serum 25(OH) vitamin D3 concentration, BMD at the radius, iPTH less than 100 pg/ml and history of fractures were independent predictors of new bone fracture after the initiation of dialysis therapy.

Conclusion

Increased bone fragility in dialysis patients is associated with vitamin D deficiency and relative hypoparathyroidism in addition to reduced BMD at the radius. Further studies are needed to determine whether patients with vitamin D deficiency benefit from vitamin D supplementation to reduce fracture risk.
Literature
1.
Alem AM, Sherrard DJ, Gillen DL et al (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399PubMedCrossRef
2.
Jadoul M, Albert JM, Akiba T et al (2006) Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the dialysis outcomes and practice patterns study. Kidney Int 70:1358–1366PubMedCrossRef
3.
Mittalhenkle A, Gillen DL, Stehman-Breen CO (2004) Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis 44:672–679PubMed
4.
Jamal SA, Hayden JA, Beyene J (2007) Low bone mineral density and fractures in long-term hemodialysis patients: a meta-analysis. Am J Kidney Dis 49:674–681PubMedCrossRef
5.
Lacativa PG, de Mendonca LM, de Mattos Patricio Filho PJ et al (2005) Risk factors for decreased total body and regional bone mineral density in hemodialysis patients with severe secondary hyperparathyroidism. J Clin Densitom 8:352–361PubMedCrossRef
6.
7.
Danese MD, Kim J, Doan QV et al (2006) PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis 47:149–156PubMedCrossRef
8.
Atsumi K, Kushida K, Yamazaki K et al (1999) Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis 33:287–293PubMedCrossRef
9.
Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36:1115–1121PubMedCrossRef
10.
Urena P, Bernard-Poenaru O, Ostertag A et al (2003) Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 18:2325–2331PubMedCrossRef
11.
Yamaguchi T, Kanno E, Tsubota J et al (1996) Retrospective study on the usefulness of radius and lumbar bone density in the separation of hemodialysis patients with fractures from those without fractures. Bone 19:549–555PubMedCrossRef
12.
Bischoff-Ferrari HA, Willett WC, Wong JB et al (2009) Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 169:551–561PubMedCrossRef
13.
Tomida K, Hamano T, Mikami S et al (2009) Serum 25-hydroxyvitamin D as an independent determinant of 1–84 PTH and bone mineral density in non-diabetic predialysis CKD patients. Bone 44:678–683PubMedCrossRef
14.
Cranney A, Weiler HA, O’Donnell S et al (2008) Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Am J Clin Nutr 88:513S–519SPubMed
15.
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692PubMedCrossRef
16.
Mucsi I, Almasi C, Deak G et al (2005) Serum 25(OH)-vitamin D levels and bone metabolism in patients on maintenance hemodialysis. Clin Nephrol 64:288–294PubMed
17.
Fournier A, Fardellone P, Achard JM et al (1999) Importance of vitamin D repletion in uraemia. Nephrol Dial Transplant 14:819–823PubMedCrossRef
18.
Pfeifer M, Begerow B, Minne HW et al (2009) Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int 20:315–322PubMedCrossRef
19.
Jamal SA, Chase C, Goh YI et al (2002) Bone density and heel ultrasound testing do not identify patients with dialysis-dependent renal failure who have had fractures. Am J Kidney Dis 39:843–849PubMedCrossRef
20.
Inaba M, Okuno S, Kumeda Y et al (2005) Increased incidence of vertebral fracture in older female hemodialyzed patients with type 2 diabetes mellitus. Calcif Tissue Int 76:256–260PubMedCrossRef
21.
Jamal SA, Gilbert J, Gordon C et al (2006) Cortical pQCT measures are associated with fractures in dialysis patients. J Bone Miner Res 21:543–548PubMedCrossRef
22.
Grotz WH, Mundinger FA, Gugel B et al (1994) Bone fracture and osteodensitometry with dual energy X-ray absorptiometry in kidney transplant recipients. Transplantation 58:912–915PubMedCrossRef
23.
Patel S, Kwan JT, McCloskey E et al (2001) Prevalence and causes of low bone density and fractures in kidney transplant patients. J Bone Miner Res 16:1863–1870PubMedCrossRef
24.
Bauer DC, Gluer CC, Genant HK et al (1995) Quantitative ultrasound and vertebral fracture in postmenopausal women. Fracture intervention trial research group. J Bone Miner Res 10:353–358PubMedCrossRef
25.
Turner CH, Peacock M, Timmerman L et al (1995) Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Osteoporos Int 5:130–135PubMedCrossRef
26.
Moayyeri A, Kaptoge S, Luben RN et al (2009) Estimation of absolute fracture risk among middle-aged and older men and women: the EPIC-Norfolk population cohort study. Eur J Epidemiol 24:259–266PubMedCrossRef
27.
Gluer CC (1997) Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The international quantitative ultrasound consensus group. J Bone Miner Res 12:1280–1288PubMedCrossRef
28.
Cadossi R, Cane V (1996) Pathways of transmission of ultrasound energy through the distal metaphysis of the second phalanx of pigs: an in vitro study. Osteoporos Int 6:196–206PubMedCrossRef
Metadata
Title
Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis
Authors
Cs. Ambrus
Cs. Almasi
K. Berta
Gy. Deak
A. Marton
M. Zs. Molnar
Zs. Nemeth
Cs. Horvath
P. Lakatos
M. Szathmari
I. Mucsi
Publication date
01-06-2011
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 2/2011
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-010-9723-x

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