Risk factors for diminished bone mineral density among male hemodialysis patients-a cross-sectional study

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Abstract

This cross-sectional study was performed to characterize the factors affecting bone mass in male hemodialysis subjects. We found that of all the factors analyzed, the strongest correlation was with body mass index. In fact, after adjusting for body weight, the correlations with bone turnover markers and sex hormones were no longer significant. Purpose: Abnormalities in bone and mineral metabolism are commonly seen in patients with end-stage renal disease, reducing bone quality and raising the risk of fracture. This cross-sectional study was performed to characterize risk factors affecting bone mass among male hemodialysis subjects. Methods: For this cross-sectional study, we recruited 66 men from three local hemodialysis units. Subjects received dual emission X-ray absorptiometry assessment of three sites (lumbar spine, hip, and distal radius) and the values were correlated with the levels of sex hormones, non-renally excreted bone turnover markers, and mineral metabolism markers. Results: Subjects were found to have bone mineral density (BMD) reduced predominantly at the distal radius, with Z score < -2 seen in 15.4 % and T score < -2.5 in 21 % of men. Independent predictors of bone density included levels of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b, which were inversely correlated with the femoral neck Z score. Factors positively associated with an increased Z score included body mass index at all sites and free estradiol levels at the hip and distal radius. Markers of mineral metabolism (e.g., calcium, phosphate, and 25-hydroxyvitamin D) were not correlated with Z scores of any site or with bone turnover markers. After adjusting for body weight, the associations between BMD, sex hormones, and bone turnover markers were no longer significant. Conclusion: We recommend that future studies seeking to assess the factors affecting bone strength among male hemodialysis subjects incorporate a weight-adjusted analysis. Additionally, dialysis-dependent men receiving dual emission X-ray absorptiometry should have the distal radius site added to the standard assessment.

Original languageEnglish (US)
Pages (from-to)283-290
Number of pages8
JournalArchives of Osteoporosis
Volume7
Issue number1-2
DOIs
StatePublished - Dec 2012

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Bone Density
Renal Dialysis
Cross-Sectional Studies
Bone Remodeling
Bone and Bones
Gonadal Steroid Hormones
Minerals
Photon Absorptiometry
Hip
Body Mass Index
Body Weight
Femur Neck
Chronic Kidney Failure
Alkaline Phosphatase
Dialysis
Estradiol
Spine
Weights and Measures

Keywords

  • Bone mineral density
  • Bone turnover markers
  • CKD-MBD
  • Dialysis
  • Dual emission X-ray absorptiometry
  • Osteoporosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

@article{fbe63ac9b3ce4e47a3938c2a2fcfe02b,
title = "Risk factors for diminished bone mineral density among male hemodialysis patients-a cross-sectional study",
abstract = "This cross-sectional study was performed to characterize the factors affecting bone mass in male hemodialysis subjects. We found that of all the factors analyzed, the strongest correlation was with body mass index. In fact, after adjusting for body weight, the correlations with bone turnover markers and sex hormones were no longer significant. Purpose: Abnormalities in bone and mineral metabolism are commonly seen in patients with end-stage renal disease, reducing bone quality and raising the risk of fracture. This cross-sectional study was performed to characterize risk factors affecting bone mass among male hemodialysis subjects. Methods: For this cross-sectional study, we recruited 66 men from three local hemodialysis units. Subjects received dual emission X-ray absorptiometry assessment of three sites (lumbar spine, hip, and distal radius) and the values were correlated with the levels of sex hormones, non-renally excreted bone turnover markers, and mineral metabolism markers. Results: Subjects were found to have bone mineral density (BMD) reduced predominantly at the distal radius, with Z score < -2 seen in 15.4 {\%} and T score < -2.5 in 21 {\%} of men. Independent predictors of bone density included levels of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b, which were inversely correlated with the femoral neck Z score. Factors positively associated with an increased Z score included body mass index at all sites and free estradiol levels at the hip and distal radius. Markers of mineral metabolism (e.g., calcium, phosphate, and 25-hydroxyvitamin D) were not correlated with Z scores of any site or with bone turnover markers. After adjusting for body weight, the associations between BMD, sex hormones, and bone turnover markers were no longer significant. Conclusion: We recommend that future studies seeking to assess the factors affecting bone strength among male hemodialysis subjects incorporate a weight-adjusted analysis. Additionally, dialysis-dependent men receiving dual emission X-ray absorptiometry should have the distal radius site added to the standard assessment.",
keywords = "Bone mineral density, Bone turnover markers, CKD-MBD, Dialysis, Dual emission X-ray absorptiometry, Osteoporosis",
author = "Sasan Mirfakhraee and Khashayar Sakhaee and Joseph Zerwekh and Beverley Adams-Huet and Ugis Gruntmanis",
year = "2012",
month = "12",
doi = "10.1007/s11657-012-0110-3",
language = "English (US)",
volume = "7",
pages = "283--290",
journal = "Archives of Osteoporosis",
issn = "1862-3522",
publisher = "Springer London",
number = "1-2",

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T1 - Risk factors for diminished bone mineral density among male hemodialysis patients-a cross-sectional study

AU - Mirfakhraee, Sasan

AU - Sakhaee, Khashayar

AU - Zerwekh, Joseph

AU - Adams-Huet, Beverley

AU - Gruntmanis, Ugis

PY - 2012/12

Y1 - 2012/12

N2 - This cross-sectional study was performed to characterize the factors affecting bone mass in male hemodialysis subjects. We found that of all the factors analyzed, the strongest correlation was with body mass index. In fact, after adjusting for body weight, the correlations with bone turnover markers and sex hormones were no longer significant. Purpose: Abnormalities in bone and mineral metabolism are commonly seen in patients with end-stage renal disease, reducing bone quality and raising the risk of fracture. This cross-sectional study was performed to characterize risk factors affecting bone mass among male hemodialysis subjects. Methods: For this cross-sectional study, we recruited 66 men from three local hemodialysis units. Subjects received dual emission X-ray absorptiometry assessment of three sites (lumbar spine, hip, and distal radius) and the values were correlated with the levels of sex hormones, non-renally excreted bone turnover markers, and mineral metabolism markers. Results: Subjects were found to have bone mineral density (BMD) reduced predominantly at the distal radius, with Z score < -2 seen in 15.4 % and T score < -2.5 in 21 % of men. Independent predictors of bone density included levels of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b, which were inversely correlated with the femoral neck Z score. Factors positively associated with an increased Z score included body mass index at all sites and free estradiol levels at the hip and distal radius. Markers of mineral metabolism (e.g., calcium, phosphate, and 25-hydroxyvitamin D) were not correlated with Z scores of any site or with bone turnover markers. After adjusting for body weight, the associations between BMD, sex hormones, and bone turnover markers were no longer significant. Conclusion: We recommend that future studies seeking to assess the factors affecting bone strength among male hemodialysis subjects incorporate a weight-adjusted analysis. Additionally, dialysis-dependent men receiving dual emission X-ray absorptiometry should have the distal radius site added to the standard assessment.

AB - This cross-sectional study was performed to characterize the factors affecting bone mass in male hemodialysis subjects. We found that of all the factors analyzed, the strongest correlation was with body mass index. In fact, after adjusting for body weight, the correlations with bone turnover markers and sex hormones were no longer significant. Purpose: Abnormalities in bone and mineral metabolism are commonly seen in patients with end-stage renal disease, reducing bone quality and raising the risk of fracture. This cross-sectional study was performed to characterize risk factors affecting bone mass among male hemodialysis subjects. Methods: For this cross-sectional study, we recruited 66 men from three local hemodialysis units. Subjects received dual emission X-ray absorptiometry assessment of three sites (lumbar spine, hip, and distal radius) and the values were correlated with the levels of sex hormones, non-renally excreted bone turnover markers, and mineral metabolism markers. Results: Subjects were found to have bone mineral density (BMD) reduced predominantly at the distal radius, with Z score < -2 seen in 15.4 % and T score < -2.5 in 21 % of men. Independent predictors of bone density included levels of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b, which were inversely correlated with the femoral neck Z score. Factors positively associated with an increased Z score included body mass index at all sites and free estradiol levels at the hip and distal radius. Markers of mineral metabolism (e.g., calcium, phosphate, and 25-hydroxyvitamin D) were not correlated with Z scores of any site or with bone turnover markers. After adjusting for body weight, the associations between BMD, sex hormones, and bone turnover markers were no longer significant. Conclusion: We recommend that future studies seeking to assess the factors affecting bone strength among male hemodialysis subjects incorporate a weight-adjusted analysis. Additionally, dialysis-dependent men receiving dual emission X-ray absorptiometry should have the distal radius site added to the standard assessment.

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KW - Bone turnover markers

KW - CKD-MBD

KW - Dialysis

KW - Dual emission X-ray absorptiometry

KW - Osteoporosis

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