1
|
Zabihiyeganeh M, Mirzaei A, Tabrizian P, Rezaee A, Sheikhtaheri A, Kadijani AA, Kadijani BA, Sharifi Kia A. Prediction of subsequent fragility fractures: application of machine learning. BMC Musculoskelet Disord 2024; 25:438. [PMID: 38834975 DOI: 10.1186/s12891-024-07559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Machine learning (ML) has shown exceptional promise in various domains of medical research. However, its application in predicting subsequent fragility fractures is still largely unknown. In this study, we aim to evaluate the predictive power of different ML algorithms in this area and identify key features associated with the risk of subsequent fragility fractures in osteoporotic patients. METHODS We retrospectively analyzed data from patients presented with fragility fractures at our Fracture Liaison Service, categorizing them into index fragility fracture (n = 905) and subsequent fragility fracture groups (n = 195). We independently trained ML models using 27 features for both male and female cohorts. The algorithms tested include Random Forest, XGBoost, CatBoost, Logistic Regression, LightGBM, AdaBoost, Multi-Layer Perceptron, and Support Vector Machine. Model performance was evaluated through 10-fold cross-validation. RESULTS The CatBoost model outperformed other models, achieving 87% accuracy and an AUC of 0.951 for females, and 93.4% accuracy with an AUC of 0.990 for males. The most significant predictors for females included age, serum C-reactive protein (CRP), 25(OH)D, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH), femoral neck Z-score, menopause age, number of pregnancies, phosphorus, calcium, and body mass index (BMI); for males, the predictors were serum CRP, femoral neck T-score, PTH, hip T-score, BMI, BUN, creatinine, alkaline phosphatase, and spinal Z-score. CONCLUSION ML models, especially CatBoost, offer a valuable approach for predicting subsequent fragility fractures in osteoporotic patients. These models hold the potential to enhance clinical decision-making by supporting the development of personalized preventative strategies.
Collapse
Affiliation(s)
- Mozhdeh Zabihiyeganeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, University of Medical Sciences, Baharestan Sq, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, University of Medical Sciences, Baharestan Sq, Tehran, Iran
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Pouria Tabrizian
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, University of Medical Sciences, Baharestan Sq, Tehran, Iran
| | - Aryan Rezaee
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, University of Medical Sciences, Baharestan Sq, Tehran, Iran
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Azade Amini Kadijani
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, University of Medical Sciences, Baharestan Sq, Tehran, Iran
| | - Bahare Amini Kadijani
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Sharifi Kia
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, University of Medical Sciences, Baharestan Sq, Tehran, Iran.
- Department of Computer Science, Faculty of Science, Western University, London, ON, Canada.
| |
Collapse
|
2
|
Zhang F, Lu J, Zhang Y, Liu J. Significance of non-motor symptoms and development of a screening tool for osteoporosis in Parkinson's disease. Clin Neurol Neurosurg 2024; 239:108181. [PMID: 38492436 DOI: 10.1016/j.clineuro.2024.108181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/30/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND PURPOSE Parkinson's disease (PD) patients have a higher likelihood of having osteoporosis compared to controls, therefore deserving special attention. This study was to 1) investigate the association of non-motor symptoms with osteoporosis amongst PD patients, and 2) develop screening tools for osteoporosis. MATERIALS AND METHODS PD Patients were included (n = 109). The factors/variables were obtained from clinical records due to the retrospective nature of this study. The bone mineral density (BMD) of the lumbar spine and femoral neck was examined using a dual-energy X-ray absorptiometry machine, according to which they were categorized as either having (T-score ≤ -2.5) or not having osteoporosis (T-score>-2.5) at the two sites. The non-motor symptoms were assessed using clinical scales, including non-motor experiences of daily living, depression, anxiety, cognitive function, and autonomic function. The potential covariates included demographic and clinical factors/variables, such as age and sex. Logistic regression was used to investigate the associations and establish the screening tools. RESULTS Patients with autonomic dysfunction had significantly (p = 0.011) higher odds of having femoral neck osteoporosis compared to those with no/minimal dysfunction after adjusting for sex, disease duration, and body mass index, demonstrating a strong association (odds ratio=12.81). Based on the four factors/variables, a screening tool with a good accuracy was established (C-statistic = 0.85). CONCLUSION PD patients with autonomic dysfunction had greater odds of having femoral neck osteoporosis compared to those with no/minimal dysfunction. The screening tool may lay a foundation for developing screening models with higher accuracy to identify which PD patients may require a BMD test.
Collapse
Affiliation(s)
- Fang Zhang
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Jianjun Lu
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yong Zhang
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiawen Liu
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| |
Collapse
|
3
|
Bover J, Gómez-Alonso C, Casado E, Rodríguez-García M, Lloret MJ, Castro-Alonso C, Gifre L, Henríquez-Palop F, Prior-Español Á, López de la Manzanara V, Láiz AM, Martínez-Ferrer À, Torregrosa JV, Cigarrán S, Górriz JL, Montomoli M, Panizo N, Costa E, Martínez-Laguna D, Rodríguez M, Navarro-González JF. Osteoporosis management in patients with chronic kidney disease (ERCOS Study): A challenge in nephrological care. Nefrologia 2024; 44:241-250. [PMID: 38531765 DOI: 10.1016/j.nefroe.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/07/2023] [Indexed: 03/28/2024] Open
Abstract
Fracture risk assessment in patients with chronic kidney disease (CKD) has been included in the CKD-MBD ("Chronic Kidney Disease-Mineral and Bone Disorders") complex in international and national nephrology guidelines, suggesting for the first time the assessment of bone mineral density (BMD) if the results can influence therapeutic decision-making. However, there is very little information on actual clinical practice in this population. The main objective of the ERCOS (ERC-Osteoporosis) study is to describe the profile of patients with CKD G3-5D with osteoporosis (OP) and/or fragility fractures treated in specialized nephrology, rheumatology and internal medicine clinics in Spain. Fifteen centers participated and 162 patients (mostly women [71.2%] postmenopausal [98.3%]) with a median age of 77 years were included. Mean estimated glomerular filtration rate (eGFR) was 36 mL/min/1.73 m2 and 38% of the included patients were on dialysis. We highlight the high frequency of prevalent fragility fractures [37.7%), mainly vertebral (52.5%) and hip (24.6%)], the disproportionate history of patients with glomerular disease compared to purely nephrological series (corticosteroids) and undertreatment for fracture prevention, especially in nephrology consultations. This study is an immediate call to action with the dissemination of the new, more proactive, clinical guidelines, and underlines the need to standardize a coordinated and multidisciplinary care/therapeutic approach to these patients in an efficient way to avoid current discrepancies and therapeutic nihilism.
Collapse
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, REMAR-IGTP Group, Can Ruti Campus, Badalona, Barcelona, Spain.
| | - Carlos Gómez-Alonso
- Unidad de Gestión Clínica de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Enrique Casado
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Minerva Rodríguez-García
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Cristina Castro-Alonso
- Servicio de Nefrología, Hospital Universitario Doctor Peset, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Laia Gifre
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Águeda Prior-Español
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Ana María Láiz
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Marco Montomoli
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Nayara Panizo
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Ester Costa
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Mariano Rodríguez
- Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan F Navarro-González
- Unidad de Investigación y Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Islas Canarias, Spain
| |
Collapse
|
4
|
Chuang TL, Koo M, Wang YF. The impact of diabetes, anemia, and renal function in the relationship between osteoporosis and fasting blood glucose among Taiwanese women: a cross-sectional study. BMC Womens Health 2024; 24:23. [PMID: 38172731 PMCID: PMC10765617 DOI: 10.1186/s12905-023-02851-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the association between fasting blood glucose and osteoporosis in women with diabetes, anemia, and renal function. METHODS The medical records of women who underwent a general health examination at a regional hospital in southern Taiwan were retrospectively reviewed. Logistic regression analysis was performed to assess the association between osteoporosis and fasting blood glucose separately for the eight subgroups (diabetes or non-diabetes, anemia or non-anemia, normal or decreased renal function), adjusting for other clinical characteristics and laboratory findings. RESULTS A total of 11,872 women were included in the study. Among women with diabetes, anemia, and decreased renal function, an increment of 10 mg/dL in fasting blood glucose was associated with an increased risk of osteoporosis (adjusted odds ratio [aOR] = 1.57, p = 0.004). Among women without diabetes, fasting blood glucose was significantly associated with an increased risk of osteoporosis in those with anemia and normal renal function (OR = 1.14, p = 0.023) and those without anemia and normal renal function (OR = 1.04, p = 0.015), but these associations were not significant after adjusting for other covariates. CONCLUSIONS Higher fasting blood glucose levels in women with diabetes, anemia, and decreased renal function were associated with an increased risk of osteoporosis. Clinicians should be vigilant about glucose control in patients with diabetes to reduce the risk of fracture.
Collapse
Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Malcolm Koo
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, 970302, Taiwan.
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11217, Taiwan.
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
| |
Collapse
|
5
|
Xiong MF, He P, Chen YH, Cao RR, Lei SF. The effect of a body shape index (ABSI) and its interaction with low estimated glomerular filtration rate (eGFR) on osteoporosis in elderly Chinese. J Orthop Sci 2024; 29:262-267. [PMID: 36550016 DOI: 10.1016/j.jos.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Both obesity and chronic kidney disease (CKD) contribute to osteoporosis risk, but the effect of a newly developed index (e.g., a body shape index, ABSI) of central obesity and its interaction with low estimated glomerular filtration rate (eGFR) on osteoporosis remains unknown. METHODS A total of 2534 Chinese individuals were enrolled in our ongoing cohort study: Osteoporosis Preventive Project. ABSI and eGFR were calculated as obesity-related indexes and renal function markers, respectively. A logistic regression model was used to estimate the association between osteoporosis and related clinical parameters (e.g., ABSI, eGFR), and to assess the additive and multiplicative interactions between risk factors and osteoporosis. Relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI) were calculated to assess the additive interaction. RESULTS High ABSI was significantly associated with an increased risk of osteoporosis in participants compared with the lowest quartile of ABSI in both crude and adjusted models. Individuals in the lower quartiles of eGFR had a significantly increased risk of osteoporosis compared with those in the highest quartiles in crude models. After adding age and other variables in the model, the association was abolished. In addition, after adjusting for variables, high ABSI with low eGFR (RERI: 0.45, 95% CI: 0.15-0.75; AP: 0.39, 95% CI: 0.17-0.60) still displayed a noticeable interaction on the risk of osteoporosis. The multiplicative interactive effect between high ABSI with low eGFR on osteoporosis was statistically significant in the multivariable-adjusted model (P < 0.05). CONCLUSION Our study indicated that higher ABSI increases the risk of osteoporosis independently and synergistically with low eGFR in Chinese elderly adults. The findings increase our understanding of the interactions of osteoporosis risk factors and may help provide potential interventions for osteoporosis.
Collapse
Affiliation(s)
- Meng-Fei Xiong
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Renai Road, Suzhou, Jiangsu 215123, PR China
| | - Pei He
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Renai Road, Suzhou, Jiangsu 215123, PR China
| | - Yong-Hao Chen
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Renai Road, Suzhou, Jiangsu 215123, PR China
| | - Rong-Rong Cao
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Renai Road, Suzhou, Jiangsu 215123, PR China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Renai Road, Suzhou, Jiangsu 215123, PR China.
| |
Collapse
|
6
|
Chen WS, Lin J, Zhang WT, Chen WJ, Gabriel EM, Kuo PC, Caycedo-Marulanda A, Cai YQ, Chen XD, Wu WY. Effect of low-level creatinine clearance on short-term postoperative complications in patients with colorectal cancer. J Gastrointest Oncol 2023; 14:2409-2424. [PMID: 38196546 PMCID: PMC10772686 DOI: 10.21037/jgo-23-811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/11/2024] Open
Abstract
Background Renal function is closely related to cancer prognosis. Since preoperative renal insufficiency has been identified as a risk factor for postoperative complications, this study aimed to investigate the effect of preoperative creatinine clearance rate (CrCl) on short-term prognosis of patients undergoing colorectal surgery. Methods A retrospective analysis was conducted of the electronic health records of 526 adult patients who underwent elective colorectal cancer (CRC) surgery from September 2014 to February 2019 at the First Affiliated Hospital of Wenzhou Medical University. Cases were divided into two groups according to CrCl level and clinical variables were compared. Risk factors associated with postoperative complications were evaluated through univariate and multivariate logistic regression analyses. Results A total of 526 patients met the inclusion criteria. The overall rate of postoperative complications was 28.14%. Overall, the incidence of postoperative complications was significantly higher in the low CrCl patients. A low-level CrCl, multi-organ combined resection, and Charlson comorbidity index (CCI) were independent risk factors for short-term complications in patients with CRC. However, a low CrCl was identified as an independent risk factor for short-term postoperative complications in elderly, but not young patients in a subgroup analysis. Conclusions Preoperative low-level CrCl, multi-organ combined resection, and CCI were significant risk factors of postoperative complications in CRC patients. Preoperative low-level CrCl and multi-organ combined resection has a poor prognostic impact for elderly patients with CRC. These findings should have important implications for health care decision-making among patients with CRC who are at higher risk for post-operative complications.
Collapse
Affiliation(s)
- Wei-Sheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ji Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei-Teng Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wen-Jing Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Emmanuel M. Gabriel
- Department of General Surgery, Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Paul C. Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Antonio Caycedo-Marulanda
- Orlando Health Colon & Rectal Institute, Orlando, FL, USA
- Division of General Surgery Queen’s University, Kingston, ON, Canada
| | - Yi-Qi Cai
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Dong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wen-Yi Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
7
|
Newman CL, Surowiec RK, Swallow EA, Metzger CE, Kim J, Tomaschke AA, Chen NX, Allen MR, Wallace JM, Moe SM, Wu YC, Niziolek PJ. Assessing cortical bone porosity with MRI in an animal model of chronic kidney disease. Bone 2023; 173:116808. [PMID: 37207990 PMCID: PMC11167728 DOI: 10.1016/j.bone.2023.116808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023]
Abstract
Chronic kidney disease (CKD) is characterized by secondary hyperparathyroidism and an increased risk of hip fractures predominantly related to cortical porosity. Unfortunately, bone mineral density measurements and high-resolution peripheral computed tomography (HR-pQCT) imaging have shortcomings that limit their utility in these patients. Ultrashort echo time magnetic resonance imaging (UTE-MRI) has the potential to overcome these limitations by providing an alternative assessment of cortical porosity. The goal of the current study was to determine if UTE-MRI could detect changes in porosity in an established rat model of CKD. Cy/+ rats (n = 11), an established animal model of CKD-MBD, and their normal littermates (n = 12) were imaged using microcomputed tomography (microCT) and UTE-MRI at 30 and 35 weeks of age (which approximates late-stage kidney disease in humans). Images were obtained at the distal tibia and the proximal femur. Cortical porosity was assessed using the percent porosity (Pore%) calculated from microCT imaging and the porosity index (PI) calculated from UTE-MRI. Correlations between Pore% and PI were also calculated. Cy/+ rats had higher Pore% than normal rats at both skeletal sites at 35 weeks (tibia = 7.13 % +/- 5.59 % vs. 0.51 % +/- 0.09 %, femur = 19.99 % +/- 7.72 % vs. 2.72 % +/- 0.32 %). They also had greater PI at the distal tibia at 30 weeks of age (0.47 +/- 0.06 vs. 0.40 +/- 0.08). However, Pore% and PI were only correlated in the proximal femur at 35 weeks of age (ρ = 0.929, Spearman). These microCT results are consistent with prior studies in this animal model utilizing microCT imaging. The UTE-MRI results were inconsistent, resulting in variable correlations with microCT imaging, which may be related to suboptimal bound and pore water discrimination at higher magnetic field strengths. Nevertheless, UTE-MRI may still provide an additional clinical tool to assess fracture risk without using ionizing radiation in CKD patients.
Collapse
Affiliation(s)
- Christopher L Newman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Rachel K Surowiec
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indianapolis, IN, United States of America
| | | | - Corinne E Metzger
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, United States of America
| | - Jieun Kim
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, United States of America
| | - Andrew A Tomaschke
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indianapolis, IN, United States of America
| | - Neal X Chen
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Matthew R Allen
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indianapolis, IN, United States of America; Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Joseph M Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indianapolis, IN, United States of America
| | - Sharon M Moe
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Paul J Niziolek
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America
| |
Collapse
|
8
|
Hu K, Cassimatis M, Nguyen M, Girgis CM. Ethnic determinants of skeletal health in female patients with fragility fracture in a culturally diverse population. Bone Rep 2023; 18:101677. [PMID: 37101568 PMCID: PMC10123337 DOI: 10.1016/j.bonr.2023.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
Background Low bone density leads to fragility fracture, with significant impact on morbidity and mortality. While ethnic differences in bone density have been observed in healthy subjects, this has not yet been explored in fragility fracture patients. Aims To assess if ethnicity is associated with bone mineral density and serum markers of bone health in female patients who experience fragility fractures. Methods 219 female patients presenting with at least one fragility fracture at a major tertiary hospital in Western Sydney Australia were studied. Western Sydney is a region with great cultural diversity, comprising people from over 170 ethnicities. Within this cohort, the three largest broad ethnic groups were Caucasians (62.1 %), Asians (22.8 %), and Middle Eastern patients (15.1 %). Location and nature of the presenting fracture and other relevant past medical history were obtained. Bone mineral density, measured by dual-energy X-ray absorptiometry, and bone-related serum markers were compared between ethnicities. Covariates (age, height, weight, diabetes, smoking, and at-risk drinking) were adjusted in multiple linear regression model. Results Although Asian ethnicity was associated with lower bone mineral density at the lumbar spine in fragility fracture patients, this association was no longer significant after adjustment for weight. Ethnicity (Asian or Middle Eastern) was not a determinant of bone mineral density at any other skeletal site. Caucasians had lower estimated glomerular filtration rate compared to Asian and Middle Eastern subjects. Serum parathyroid hormone concentrations were significantly lower in Asians compared to other ethnicities. Conclusion Asian ethnicity and Middle Eastern ethnicity were not major determinants of bone mineral density at the lumbar spine, femoral neck, or total hip.
Collapse
Affiliation(s)
- Katherine Hu
- Sydney Medical School, University of Sydney, Sydney, Australia
- Corresponding author.
| | - Maree Cassimatis
- Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Minh Nguyen
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia
| | - Christian M. Girgis
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Ye Y, Yi X, Zhang Y, Xu G, Yu M, Qu X. Association between renal function and bone mineral density in patients with type 2 diabetes mellitus. Heliyon 2023; 9:e15967. [PMID: 37215877 PMCID: PMC10195895 DOI: 10.1016/j.heliyon.2023.e15967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
Background This study evaluated the association between renal function, assessed by serum creatinine and estimated glomerular filtration rate (eGFR) according to the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations, and bone mineral density (BMD) in Chinese patients with type 2 diabetes mellitus (T2DM). Methods 1322 patients with T2DM were included, and their basic clinical information, serum biochemical tests, and BMD at the total hip and femur neck were collected. Multivariate adjusted linear regression, smooth curve fitting and a piecewise linear regression model were used to analyze linear and nonlinear associations. Age, BMI, drinking, smoking, systolic blood pressure and diastolic blood pressure, FBG, HbA1C, course of diabetes, hsCRP, TC, TG, HDL-C, LDL-C, Ca, P, PTH, ALP, OC, P1NP, β-CTX and 25(OH)D were adjusted. Results After adjusting the variables, no correlation between eGFR CG and eGFR MDRD and femur neck BMD was observed in women, men, or the total population. The eGFR CG and eGFR MDRD had a significant positive association with total hip BMD in men and the total population with T2DM. With a 10-unit decrease in eGFR CG, total hip BMD reduced by 0.012 g/cm2 in men and 0.010 g/cm2 the total population. Total hip BMD reduced by 0.014 g/cm2 in men and 0.022 g/cm2 in the total population with a 10-unit decrease in eGFR MDRD. There was no correlation between eGFR CG or eGFR MDRD and total hip BMD in female participants. Conclusion Impaired renal function was associated with decreased total hip BMD in men and the total population with T2DM. No associated between renal function with femur neck BMD was observed.
Collapse
Affiliation(s)
- Yangli Ye
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xilu Yi
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Endocrinology and Metabolism, Central Hospital of Songjiang District, Shanghai, China
| | - Yao Zhang
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Infectious Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guiping Xu
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China
- VIP Clinical Department, Fujian Provincial Hospital, Fuzhou, China
| | - Mingxiang Yu
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xinhua Qu
- Department of Bone and Joint Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
10
|
Bae WC. Advances and Shortfalls in MRI Evaluation of Osteoporosis. Radiology 2023; 307:e223144. [PMID: 36692406 PMCID: PMC10102620 DOI: 10.1148/radiol.223144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Won C. Bae
- From the Department of Radiology, University of California San Diego, 9427 Health Sciences Dr, La Jolla, CA 92093
| |
Collapse
|
11
|
Goodwin Davies AJ, Xiao R, Razzaghi H, Bailey LC, Utidjian L, Gluck C, Eckrich D, Dixon BP, Deakyne Davies SJ, Flynn JT, Ranade D, Smoyer WE, Kitzmiller M, Dharnidharka VR, Magnusen B, Mitsnefes M, Somers M, Claes DJ, Burrows EK, Luna IY, Furth SL, Forrest CB, Denburg MR. Skeletal Outcomes in Children and Young Adults with Glomerular Disease. J Am Soc Nephrol 2022; 33:2233-2246. [PMID: 36171052 PMCID: PMC9731624 DOI: 10.1681/asn.2021101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 08/10/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking. METHODS This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours. RESULTS We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio [IRR], 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5). CONCLUSIONS Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.
Collapse
Affiliation(s)
- Amy J Goodwin Davies
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanieh Razzaghi
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L Charles Bailey
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Levon Utidjian
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline Gluck
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Daniel Eckrich
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Bradley P Dixon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | | | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
| | | | - William E Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | | | - Vikas R Dharnidharka
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- St. Louis Children's Hospital, St. Louis, Missouri
| | | | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Michael Somers
- Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Donna J Claes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Evanette K Burrows
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ingrid Y Luna
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan L Furth
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher B Forrest
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R Denburg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
12
|
A New Index Based on Serum Creatinine and Cystatin C Can Predict the Risks of Sarcopenia, Falls and Fractures in Old Patients with Low Bone Mineral Density. Nutrients 2022; 14:nu14235020. [PMID: 36501049 PMCID: PMC9738634 DOI: 10.3390/nu14235020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
As new screening tools for sarcopenia, the serum sarcopenia index (SI) and creatinine/cystatin C ratio (CCR) had not been confirmd in a population with a high fragility fracture risk. This study aimed to evaluate whether SI and CCR indicators are useful for diagnosing sarcopenia and to determine their prediction values for future falls and fractures. A total of 404 hospitalized older adults were enrolled in this longitudinal follow-up study (mean age = 66.43 ± 6.80 years). The receiver operating curve (ROC) was used to assess the diagnostic accuracy of SI and CCR. Backward-selection binary logistic regression was applied to develop the optimal models for the diagnosis of new falls and fractures. SI had a significantly higher area under the curve (AUC) than CCR for predicting sarcopenia. The optimal models had acceptable discriminative powers for predicting new falls and fractures. Lower SI and CCR are the independent risks for sarcopenia, new falls, and fractures in the low-BMD population. SI and CCR, as easily accessible biochemical markers, may be useful in the detection of sarcopenia and in predicting the occurrence of new falls and fractures in patients with low BMD who have not previously experienced falls or fractures. However, further external validations are required.
Collapse
|
13
|
Khelifi N, Desbiens L, Sidibé A, Mac‐Way F. Vitamin D Analogues and Fracture Risk in Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. JBMR Plus 2022; 6:e10611. [PMID: 35434454 PMCID: PMC9009117 DOI: 10.1002/jbm4.10611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Vitamin D receptor agonists (VDRAs) are commonly prescribed in chronic kidney disease (CKD). However, their protective effects on bone remain controversial. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of VDRAs on fracture risk and bone mineral density (BMD) in adult patients with CKD. We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and the WHO's International Clinical Trials Registry Platform databases from inception to June 19, 2021. We included RCTs comparing VDRAs, to placebo or another medication, in adults with CKD requiring or not dialysis. Conference abstracts and trials involving kidney transplant recipients and/or comparing VDRAs to antiresorptive or anabolic bone therapy were excluded. Primary outcome was fracture at any anatomical site. Secondary outcomes were BMD at femoral neck, lumbar spine, and/or total hip. Prespecified subgroup analyses were conducted according to baseline demographics, overall risk of bias, and follow-up time. From 6868 references retrieved, eight RCTs were eligible: five reported fracture, two reported BMD, and one reported both outcomes. As comparator, one study used no VDRAs, one used nutritional intervention and no medication, and six used placebo. In meta-analysis, VDRAs were not associated with a significant reduction in total fractures in overall (risk ratio = 0.79, 95% confidence interval 0.38-1.65, I2 = 0%, six trials, 1507 participants, 27 fractures) or in prespecified subgroup analyses. Three trials reported BMD at different sites and with different BMD measurements; thus, a meta-analysis could not be performed. Two RCTs were at high risk of bias, notably because of deviations from the intended interventions. As limitation, we have to mention the low total number of fractures included in our meta-analysis. In conclusion, current evidence from RCTs is insufficient to associate VDRAs with bone protection in CKD. Further large and long-term studies specifically designed to evaluate the efficacy of VDRAs on bone outcomes are thus required. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Nada Khelifi
- CHU de Québec Research Center, Division of NephrologyEndocrinology and Nephrology AxisQuebec CityCanada
- Faculty and Department of MedicineUniversité LavalQuebec CityCanada
| | - Louis‐Charles Desbiens
- CHU de Québec Research Center, Division of NephrologyEndocrinology and Nephrology AxisQuebec CityCanada
- Faculty and Department of MedicineUniversité LavalQuebec CityCanada
| | - Aboubacar Sidibé
- CHU de Québec Research Center, Division of NephrologyEndocrinology and Nephrology AxisQuebec CityCanada
- Faculty of Medicine, Department of Social and Preventive MedicineUniversité LavalQuebec CityCanada
| | - Fabrice Mac‐Way
- CHU de Québec Research Center, Division of NephrologyEndocrinology and Nephrology AxisQuebec CityCanada
- Faculty and Department of MedicineUniversité LavalQuebec CityCanada
| |
Collapse
|
14
|
Guan Y, Lu YH, Lei SF. Physical activities mediate the correlations between serum creatinine and bone mineral density in Chinese. Clin Chim Acta 2022; 524:25-33. [PMID: 34843706 DOI: 10.1016/j.cca.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between serum creatinine (CR) and osteoporosis under normal renal function and the possible mediating effects mediated by physical activity (PA) are largely unknown. METHODS A total of 4,137 elderly Chinese subjects were recruited. Three models including different covariates were established. Correlation analysis and multiple linear regression analysis were used to evaluate the relationship between CR and bone mineral density (BMD) and also under different PA pattern. Logistic regression was used to investigate the interaction between CR*PA with osteoporosis. PA was used as a moderating variable to investigate the relationship between CR and BMD. RESULTS As we expected, the association between CR and BMD remained significant after adjusting covariates in all models. The relationship between CR and BMD showed changeable pattern in case of different physical activity. Specially, the moderating effects of PA on serum creatinine and BMD were significant for all models only in the case of medium physical activity (PA3). CONCLUSIONS In Chinese elderly under normal renal function, serum CR is positively correlated with BMD, and medium physical activity has mediation effect on such correlation.
Collapse
Affiliation(s)
- Yu Guan
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China
| | - Yi-Hua Lu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China; Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu 226019, PR China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China.
| |
Collapse
|
15
|
Nalevaiko JZ, Marques JVO, Oliveira MF, Raetsch AWP, Marques GL, Petterle RR, Moreira CA, Borba VZC. Bone density and quality in patients treated with direct-acting oral anticoagulants versus warfarin. Bone 2021; 150:116000. [PMID: 33971316 DOI: 10.1016/j.bone.2021.116000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/23/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Direct-acting oral anticoagulants (DOACs) are therapeutic alternatives to warfarin that act independently of vitamin K, thus not affecting bone matrix formation. The aim of this study was to compare bone mineral density (BMD) and microarchitecture in patients treated with DOACs versus warfarin. METHODS Cross-sectional, observational study in patients using oral anticoagulants for >1 year and a paired control group (CG). Based on the type of anticoagulant used, the patients were grouped into a DOAC (DOACG) or warfarin (WG) group. All patients filled out a questionnaire and underwent BMD evaluation and trabecular bone score (TBS) measurement. RESULTS In all, 150 patients were included (50 patients in each group). The mean age was 60.49 ± 7.48 years, and most participants were men (64%). The most frequent comorbidities were hypertension, dyslipidemia, and hyperglycemia (comparison between groups p > 0.05). Low bone mass was diagnosed in 42%, 50%, and 66% of the patients in the CG, DOACG, and WG, respectively (p = 0.012). On logistic regression analysis, BMD was associated with body mass index (BMI; odds ratio [OR] 0.846, 95% confidence interval [CI] 0.763-0.926, p = 0.001), creatinine level (OR 0.024, 95%CI 0.001-0.434, p = 0.017), and TBS value (OR 17.777, 95%CI 4.526-96.903, p = 0.000). The mean TBS decreased progressively from the CG to the DOACG and WG (1.328 ± 0.112, 1.264 ± 0.138, and 1.203 ± 0.112, respectively, p < 0.001). On multivariate linear regression, negative predictors of TBS included warfarin use (-0.06, 95%CI -0.11 to -0.02, p = 0.006), BMI (-0.01, 95%CI -0.01 to -0.00, p < 0.001), and hyperglycemia (-0.07, 95%CI -0.11 to -0.03, p = 0.003), while positive predictors were an active IPAQ classification (0.06, 95%CI 0.01-0.11, p = 0.029) and family history of hip fracture (0.07, 95%CI 0.01-0.14, p = 0.029). CONCLUSION Patients using anticoagulants have lower BMD and TBS values compared with controls. This negative effect on bone was more pronounced with warfarin, but was also seen with DOACs.
Collapse
Affiliation(s)
- Jeferson Zanovelli Nalevaiko
- Cardiology Division, Hospital de Clínicas, Universidade Federal do Paraná (HC/UFPR), Rua General Carneiro, 181 Curitiba, PR, Brazil
| | - Júlia Vieira Oberger Marques
- Endocrine Division, Hospital de Clínicas, Universidade Federal do Paraná (SEMPR), Avenida Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR, Brazil
| | | | | | - Gustavo Lenci Marques
- Cardiology Division, Hospital de Clínicas, Universidade Federal do Paraná (HC/UFPR), Rua General Carneiro, 181 Curitiba, PR, Brazil
| | | | - Carolina Aguiar Moreira
- Endocrine Division, Hospital de Clínicas, Universidade Federal do Paraná (SEMPR), Avenida Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR, Brazil
| | - Victória Zeghbi Cochenski Borba
- Endocrine Division, Hospital de Clínicas, Universidade Federal do Paraná (SEMPR), Avenida Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR, Brazil.
| |
Collapse
|
16
|
Chen Y, Yang T, Gao X, Xu A. Hybrid deep learning model for risk prediction of fracture in patients with diabetes and osteoporosis. Front Med 2021; 16:496-506. [PMID: 34448125 DOI: 10.1007/s11684-021-0828-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/17/2020] [Indexed: 12/01/2022]
Abstract
The fracture risk of patients with diabetes is higher than those of patients without diabetes due to hyperglycemia, usage of diabetes drugs, changes in insulin levels, and excretion, and this risk begins as early as adolescence. Many factors including demographic data (such as age, height, weight, and gender), medical history (such as smoking, drinking, and menopause), and examination (such as bone mineral density, blood routine, and urine routine) may be related to bone metabolism in patients with diabetes. However, most of the existing methods are qualitative assessments and do not consider the interactions of the physiological factors of humans. In addition, the fracture risk of patients with diabetes and osteoporosis has not been further studied previously. In this paper, a hybrid model combining XGBoost with deep neural network is used to predict the fracture risk of patients with diabetes and osteoporosis, and investigate the effect of patients' physiological factors on fracture risk. A total of 147 raw input features are considered in our model. The presented model is compared with several benchmarks based on various metrics to prove its effectiveness. Moreover, the top 18 influencing factors of fracture risks of patients with diabetes are determined.
Collapse
Affiliation(s)
- Yaxin Chen
- Department of Pharmacy, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.,Shanghai Key Laboratory of Scalable Computing and Systems, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Tianyi Yang
- Shanghai Key Laboratory of Scalable Computing and Systems, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xiaofeng Gao
- Shanghai Key Laboratory of Scalable Computing and Systems, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Ajing Xu
- Department of Pharmacy, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China. .,Clinical Research Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.
| |
Collapse
|
17
|
Abstract
Introduction Chronic kidney disease (CKD) exposes to an increased incidence of fragility fractures. International guidelines recommend performing bone mineral density (BMD) if the results will impact treatment decisions. It remains unknown where bone loss occurs and what would preclude the longitudinal loss in patients with CKD. Here, we aimed to investigate factors influencing BMD and to analyze the longitudinal BMD changes. Methods In the NephroTest cohort, we measured BMD at the femoral neck, total hip, lumbar spine, and proximal radius, together with circulating biomarkers and standardized measured glomerular filtration rate (mGFR) by 51Cr-EDTA in a subset of patients with CKD stage 1 to 5 followed during 4.3 ± 2.0 years. A linear mixed model explored the longitudinal bone loss and the relationship of associated factors with BMD changes. A total of 858 patients (mean age 58.9 ± 15.2 years) had at least 1 and 477 had at least 2 BMD measures. Results At baseline, cross-sectional analysis showed a significantly lower BMD at femoral neck and total hip and a significant higher serum parathyroid hormone (PTH) along with CKD stages. Baseline age, gender, tobacco, low body mass index (BMI), and high PTH levels were significantly associated with low BMD. Longitudinal analysis during the mean 4.3 years revealed a significant bone loss at the radius only. BMD changes at the femoral neck were associated with BMI, but not CKD stages or basal PTH levels. Conclusions CKD is associated with low BMD and high PTH in the cross-sectional analysis. Longitudinal bone loss occurred at the proximal radius after 4.3 years.
Collapse
|
18
|
Desbiens LC, Goupil R, Madore F, Mac-Way F. Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE. Nephrol Dial Transplant 2021; 35:1712-1721. [PMID: 31951261 DOI: 10.1093/ndt/gfz259] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals. METHODS We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added. RESULTS A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05-1.49) for 60 mL/min/1.73 m2; 1.65 (1.14-2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence <75 mL/min/1.73 m2 [HR = 1.18 (1.04-1.34) per 10 mL/min/1.73 m2 decrease] but not above [HR = 0.98 (0.91-1.06) per 10 mL/min/1.73 m2 decrease). The effect of decreased eGFR on fracture incidence was more pronounced in younger individuals [HR = 2.45 (1.28-4.67) at 45 years; 1.11 (0.73-1.67) at 65 years] and in men. CONCLUSIONS Even early CKD increases fracture incidence, especially in younger individuals and in men.
Collapse
Affiliation(s)
- Louis-Charles Desbiens
- Faculty and Department of Medicine, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Rémi Goupil
- Hôpital du Sacré-Coeur de Montréal, Faculty and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - François Madore
- Hôpital du Sacré-Coeur de Montréal, Faculty and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Fabrice Mac-Way
- Faculty and Department of Medicine, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval, Quebec City, QC, Canada
| |
Collapse
|
19
|
Pongchaiyakul C, Nanagara R, Songpatanasilp T, Unnanuntana A. Cost-effectiveness of denosumab for high-risk postmenopausal women with osteoporosis in Thailand. J Med Econ 2020; 23:776-785. [PMID: 32063082 DOI: 10.1080/13696998.2020.1730381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: This study assessed the cost-effectiveness of denosumab for treating postmenopausal women with osteoporosis (PMO) at high risk of fracture in Thailand.Materials and methods: A published Markov cohort cost-effectiveness model was populated with country-specific data as available and other published data as needed. The model used a societal perspective, lifetime horizon, efficacy data from network meta-analysis of trials, and included costs for direct medical and non-medical care, informal care, and osteoporosis treatments to compare denosumab to no pharmacologic treatment (calcium and vitamin D supplements only) and to oral weekly alendronate. The base case (high-risk population) included postmenopausal women with femoral neck T-score ≤-2.5, mean age 65 years at entry, and history of vertebral fracture.Results: High-risk women with osteoporosis using denosumab had the greatest number of life years and quality-adjusted life-years (QALYs) with higher reductions in hip and vertebral fracture incidence compared with patients with no pharmacologic treatment. The incremental cost-effectiveness ratio (ICER) was 119,575 Thai Baht (THB) per QALY for denosumab versus no pharmacologic treatment and 199,186 THB per QALY for denosumab versus alendronate. Among Thai postmenopausal women with high-risk of fractures, denosumab was cost-effective compared with no pharmacologic treatment at a willingness-to-pay threshold of 160,000 THB per QALY. One-way sensitivity analysis showed models were most sensitive to changes in denosumab pricing.Limitations: Data from other countries used when country-specific data were unavailable may not accurately reflect the true experience in Thailand. The model focused explicitly on hip, vertebral, and wrist fractures, and therefore provides a conservative estimate of the overall potential impact of osteoporosis-related fracture. The fracture risk was not adjusted to reflect potential changes in risk after denosumab treatment discontinuation.Conclusions: In Thailand, denosumab offers a cost-effective osteoporosis treatment option versus no pharmacologic treatment in postmenopausal women at high risk of fracture.
Collapse
Affiliation(s)
| | | | | | - Aasis Unnanuntana
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| |
Collapse
|
20
|
Desbiens LC, Goupil R, Mac-Way F. Predictive value of quantitative ultrasound parameters in individuals with chronic kidney disease: A population-based analysis of CARTaGENE. Bone 2020; 130:115120. [PMID: 31676408 DOI: 10.1016/j.bone.2019.115120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/11/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of calcaneal quantitative ultrasound (QUS) to predict fractures has not been well studied in early CKD populations. We compared the association of QUS with incidental fractures and its predictive properties in non-CKD and CKD individuals. METHODS Analysis of a prospective population-based survey of 40- to 69-year-old individuals recruited between 2009 and 2010. QUS parameters (stiffness index [SI], speed of sound [SOS], broadband attenuation [BUA]) were measured at baseline. Renal function was measured using baseline creatinine and was classified into CKD stages (non-CKD, stage 2, stage 3). Fracture incidence at any site or at major osteoporotic fracture sites for up to 7 years of follow-up was identified in administrative databases using a validated algorithm. The association (age-adjusted hazard ratio per standard deviation decrease in Cox models), discrimination (c-statistic) and calibration (standardized incidence ratio [SIR]) of QUS parameters with fracture outcomes was computed in each CKD stratum. RESULTS We included 18,306 individuals (9,011 non-CKD; 8,595 CKD stage 2; 700 CKD stage 3). During a median follow-up of 70 months, we identified 782 fractures at any site and 326 major osteoporotic fractures. Although all QUS parameters (SI, SOS and BUA) were associated with any or major fracture incidence in non-CKD and CKD patients, the magnitude of these associations was lower for any fracture and for BUA. QUS parameters moderately discriminated incidental fractures across CKD strata but underestimated fracture incidence in CKD stage 3 even after adjustment for demographics and clinical risk factors. At a given QUS value, CKD stage 3 patients had higher fracture risk than non-CKD and CKD stage 2 patients. CONCLUSIONS QUS parameters are associated with fracture incidence in both non-CKD and CKD but underestimate fracture incidence in individuals with early CKD.
Collapse
Affiliation(s)
- Louis-Charles Desbiens
- CHU de Québec Research Center, L'Hôtel-Dieu-de-Québec 10 McMahon, Quebec City, QC, G1R 2J6, Canada; Department and Faculty of Medicine, Université Laval. 1050, avenue de la Médecine, local 4211, Quebec City, QC, G1V 0A6, Canada.
| | - Rémi Goupil
- Hôpital du Sacré-Coeur de Montréal, Nephrology Division, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada; Department and Faculty of Medicine, Université de Montréal, 2900, boul. Édouard-Montpetit, local S-759, Montreal, QC, H3T 1J4, Canada.
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L'Hôtel-Dieu-de-Québec 10 McMahon, Quebec City, QC, G1R 2J6, Canada; Department and Faculty of Medicine, Université Laval. 1050, avenue de la Médecine, local 4211, Quebec City, QC, G1V 0A6, Canada.
| |
Collapse
|
21
|
Huang JF, Zheng XQ, Sun XL, Zhou X, Liu J, Li YM, Wang XY, Zhang XL, Wu AM. Association between Bone Mineral Density and Severity of Chronic Kidney Disease. Int J Endocrinol 2020; 2020:8852690. [PMID: 33193760 PMCID: PMC7641666 DOI: 10.1155/2020/8852690] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jin-Feng Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xuan-Qi Zheng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao-Lei Sun
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xiao Zhou
- Ruian Institute of Quality and Technical Supervision and Inspection, Wenzhou 325000, China
| | - Jian Liu
- Department of Nephrology, Rui Jin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
| | - Yan Michael Li
- Department of Neurosurgery and Oncology, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Xiang-Yang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao-Lei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Ai-Min Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| |
Collapse
|
22
|
Malmgren L, McGuigan FE, Christensson A, Akesson KE. Kidney function and its association to imminent, short- and long-term fracture risk-a longitudinal study in older women. Osteoporos Int 2020; 31:97-107. [PMID: 31754754 PMCID: PMC6946753 DOI: 10.1007/s00198-019-05152-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/28/2019] [Indexed: 11/27/2022]
Abstract
Reduced kidney function is associated with an increased fracture risk, although the relationship between an age-related decline and fractures needs further investigation. We followed kidney function and fracture risk for 10 years. A mild-moderate decline in kidney function was associated with fracture, but not in advanced age. INTRODUCTION With age, kidney function declines. Though well known that chronic kidney disease is associated with increased fracture risk, the extent to which the typical age-related decline contributes is unclear. In the OPRA cohort, a longitudinal study of older non-selected women, we investigated the association between kidney function and fracture. METHODS Cystatin C-based kidney function estimates were available at age 75 (n = 981) and 80 (n = 685). Women were categorized by kidney function: normal (CKD stages 1 and 2), mild-moderate (3a), poor (3b-5), and imminent, short- and long-term fracture risk investigated. BMD measurements and kidney function for risk prediction were also evaluated; women were categorized by both reduced kidney function (stages 3-5) and osteoporosis status. RESULTS In the short term, 2-3 years, mild-moderate kidney dysfunction was associated with the highest risk increase: osteoporotic fractures (2 years HRadj 2.21, 95% CI 1.27-3.87) and also up to 5 years (between 75 and 80 years) (HRadj 1.51, 1.04-2.18). Hip fracture risk was similarly increased. This association was not observed from age 80 nor for women with poorest kidney function. Reduced kidney function was associated with higher risk even without osteoporosis (osteoporotic fracture; HRadj 1.66, 1.08-2.54); risk increased by having both osteoporosis and reduced function (HRadj 2.53, 1.52-4.23). CONCLUSION Older women with mild-moderate reduction of kidney function are at increased risk of fractures, but not those with the worst function. Our findings furthermore confirm the value of osteoporosis assessment and it is possible that in this age group, age-related decline of kidney function has limited contribution compared with BMD.
Collapse
Affiliation(s)
- L Malmgren
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden
- Department of Geriatrics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - F E McGuigan
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden
- Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden
| | - A Christensson
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden
- Department of Nephrology, Skåne University Hospital, S-205 02, Malmö, Sweden
| | - K E Akesson
- Department of Clinical Sciences Malmö, Lund University, 214 28, Malmö, Sweden.
- Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden.
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW To summarize the literature regarding alterations in bone health in patients with glomerular kidney disease and highlight areas in need of additional investigation. RECENT FINDINGS There is mounting evidence that children and adults with glomerular conditions, with or without compromised kidney function, comprise a distinct subgroup of patients with unique risk factors for altered bone health. Patients with glomerular kidney disease are exposed to both disease-related and treatment-related factors that affect bone structure and function. In addition to chronic kidney disease-related risk factors for impaired bone health, high rates of exposure to osteotoxic medications, varying degrees of systemic inflammation, and altered vitamin D metabolism may contribute to compromised bone health in individuals with glomerular disease. Further study is needed to better understand these risk factors and the complex interaction between the immune system and bone cells in glomerular disease.
Collapse
Affiliation(s)
- Dorey A Glenn
- UNC Kidney Center, Universirty of North Carolina at Chapel Hill, 7024 Burnett Womack Building, Chapell Hill, NC, 27599-7155, USA
| | - Michelle R Denburg
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
24
|
Granchi D, Baldini N, Ulivieri FM, Caudarella R. Role of Citrate in Pathophysiology and Medical Management of Bone Diseases. Nutrients 2019; 11:E2576. [PMID: 31731473 PMCID: PMC6893553 DOI: 10.3390/nu11112576] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Citrate is an intermediate in the "Tricarboxylic Acid Cycle" and is used by all aerobic organisms to produce usable chemical energy. It is a derivative of citric acid, a weak organic acid which can be introduced with diet since it naturally exists in a variety of fruits and vegetables, and can be consumed as a dietary supplement. The close association between this compound and bone was pointed out for the first time by Dickens in 1941, who showed that approximately 90% of the citrate bulk of the human body resides in mineralised tissues. Since then, the number of published articles has increased exponentially, and considerable progress in understanding how citrate is involved in bone metabolism has been made. This review summarises current knowledge regarding the role of citrate in the pathophysiology and medical management of bone disorders.
Collapse
Affiliation(s)
- Donatella Granchi
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Nicola Baldini
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Via Pupilli 1, University of Bologna, 40136 Bologna, Italy
| | - Fabio Massimo Ulivieri
- Nuclear Medicine, Bone Metabolic Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milano, Italy;
| | - Renata Caudarella
- Maria Cecilia Hospital, GVM Care and Research, Via Corriera 1, 48033 Cotignola (RA), Italy;
| |
Collapse
|
25
|
Chuang TL, Chuang MH, Lin CH, Chou SC, Wang YF. Significant association factors of bone mineral density in Taiwan adults. Tzu Chi Med J 2019; 32:367-372. [PMID: 33163383 PMCID: PMC7605296 DOI: 10.4103/tcmj.tcmj_113_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/11/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022] Open
Abstract
Objective: To examine the biofactors associated with bone mineral density (BMD) in southern Taiwanese adults. Materials and Methods: The medical records of 3242 adults who underwent health examinations between June 2014 and February 2018 at a regional hospital in southern Taiwan were reviewed. The data collected included health history, anthropomorphic characteristics, clinical laboratory results, biochemical parameters, and BMD. The data were used to identify the biofactors associated with BMD/T-scores at the lumbar spine and femoral neck by multivariate linear regression analysis with the stepwise method. Results: The mean age of the patients was 58.1 years, and 71.4% were male. Factors positively correlated with BMD and the T-score included body mass index (BMI), male gender, calcium, and creatinine. Age, alkaline phosphatase (ALP), triiodothyronine, serum thyroxine, low-density lipoprotein cholesterol, and a history of hyperlipidemia were negatively correlated with BMD and the T-score. Conclusion: The associated biofactors reported here were similar to and had similar relationships as the biofactors identified in previous literature reports. Not all of the sites examined for BMD were influenced by the same association factors, except for BMI, male gender, age, and ALP, implying that the bone remodeling processes that shape BMD involve a complex regulatory network and demonstrating that our extracted factors are the most useful for clinical practice.
Collapse
Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Hua Chuang
- Faculty of Pharmacy, National Yang-Ming University, Taipei, Taiwan.,Department of Pharmacology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chun-Hung Lin
- Department of General Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Shih-Chin Chou
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Center of Preventive Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| |
Collapse
|
26
|
Kwon YE, Choi HY, Kim S, Ryu DR, Oh HJ. Fracture risk in chronic kidney disease: A Korean population-based cohort study. Kidney Res Clin Pract 2019; 38:220-228. [PMID: 31067609 PMCID: PMC6577209 DOI: 10.23876/j.krcp.18.0099] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/16/2018] [Accepted: 01/16/2019] [Indexed: 12/26/2022] Open
Abstract
Background Chronic kidney disease (CKD)-mineral and bone disorder (MBD) and fracture risk are both closely related to declining renal function. Controlling hyperphosphatemia with phosphate binders is a basic principle of CKD-MBD treatment. The aim of this study was to identify differences in fracture risk between pre-dialysis CKD patients and end-stage renal disease (ESRD) on dialysis, and to evaluate the effects of phosphate binders on fracture risk in ESRD patients. Methods Data from a total of 89,533 CKD patients comprising CKD diagnosis, dialysis, fracture history, and phosphate binder prescription history from 2012 to 2016 were retrieved from the Health Insurance Review and Assessment Service Database. Multivariate Cox regression analyses were performed to identify whether dialysis or phosphate binders were associated with an increased fracture risk. Results Overall, the rate of fractures in pre-dialysis CKD patients was 74 per 1,000 patient-years, while that in dialysis patients was 84 per 1,000 patient-years. The risk of fracture in ESRD patients was higher than pre-dialysis CKD patients (hazard ratio, 1.16; 95% confidence interval, 1.12–1.21; P < 0.001) after adjusting for confounding variables. In addition, the fracture risk in patients who were not taking phosphate binders was 20.0% higher compared to ESRD patients taking phosphate binders. Conclusion Fractures were more prevalent in ESRD patients on dialysis than pre-dialysis CKD patients. Use of phosphate binders was associated with a lower fracture risk in ESRD patients.
Collapse
Affiliation(s)
- Young Eun Kwon
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | | | - Sol Kim
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyung Jung Oh
- Ewha Institute of Convergence Medicine and Research Institute for Human Health Information, Ewha Womans University, Seoul, Korea
| | | |
Collapse
|
27
|
Aleksova J, Ng KW, Jung C, Zeimer H, Dwyer KM, Milat F, MacIsaac RJ. Bone health in chronic kidney disease-mineral and bone disorder: a clinical case seminar and update. Intern Med J 2019; 48:1435-1446. [PMID: 30302919 DOI: 10.1111/imj.14129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 08/15/2018] [Accepted: 08/25/2018] [Indexed: 12/14/2022]
Abstract
The metabolic abnormalities affecting bone in the setting of chronic kidney disease (CKD) are complex with overlapping and interacting aetiologies and have challenging diagnostic and management strategies. Disturbances in calcium, phosphate, fibroblast growth factor 23, parathyroid hormone concentrations and vitamin D deficiency are commonly encountered and contribute to the clinical syndromes of bone disorders in CKD, including hyperparathyroidism, osteomalacia, osteoporosis and adynamic bone disease. Mineral and bone abnormalities may also persist or arise de novo post-renal transplantation. The Kidney Disease Improving Global Outcomes organisation describes these mineral metabolism derangements and skeletal abnormalities as 'CKD Mineral and Bone Disorder'. Patients with this disorder have an increased risk of fracture, cardiovascular events and overall increased mortality. In light of the recently updated 2017 guidelines from the Kidney Disease Improving Global Outcomes, we present a clinical case-based discussion to highlight the complexities of investigating and managing the bone health of patients with CKD with a focus on these updates.
Collapse
Affiliation(s)
- Jasna Aleksova
- Hudson Institute for Medical Research, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kong W Ng
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Caroline Jung
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Howard Zeimer
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Karen M Dwyer
- School of Medicine, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Frances Milat
- Hudson Institute for Medical Research, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
28
|
Aleksova J, Rodriguez AJ, McLachlan R, Kerr P, Milat F, Ebeling PR. Gonadal Hormones in the Pathogenesis and Treatment of Bone Health in Patients with Chronic Kidney Disease: a Systematic Review and Meta-Analysis. Curr Osteoporos Rep 2018; 16:674-692. [PMID: 30328552 DOI: 10.1007/s11914-018-0483-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Patients with chronic kidney disease (CKD) have a greatly increased fracture risk compared with the general population. Gonadal hormones have an important influence on bone mineral density (BMD) and fracture risk, and hormone therapies can significantly improve these outcomes. Gonadal dysfunction is a frequent finding in patients with CKD; yet, little is known about the impact of gonadal hormones in the pathogenesis and treatment of bone health in patients with CKD. This systematic review and meta-analysis aimed to examine the effects of gonadal hormones and hormone therapies on bone outcomes in men and women with CKD. METHODS EMBASE, MEDLINE, SCOPUS, and clinical trial registries were systematically searched from inception to February 14, 2018 for studies that assessed gonadal hormones or hormone treatments with bone outcomes in patients with CKD stage 3-5D. Two independent reviewers screened the titles and abstracts of search results according to inclusion criteria and assessed study quality and risk of bias using validated assessment tools. RECENT FINDINGS Thirteen studies met the inclusion criteria. Six moderate-to-high quality observational studies showed inconsistent association between any gonadal hormone and bone outcomes, limited by significant study heterogeneity. Five moderate-high risk of bias interventional studies examined treatment with selective oestrogen receptor modulators in post-menopausal women (four using raloxifene and one bazedoxifene) and demonstrated variable effects on BMD and fracture outcomes. Meta-analysis of raloxifene treatment in post-menopausal women demonstrated improvement in lumbar spine (SMD 3.30; 95% CI 3.21-3.38) and femoral neck (SMD 3.29; 95% CI 3.21-3.36) BMD compared with placebo. Transdermal oestradiol/norethisterone in pre-menopausal women receiving dialysis (n = 1 study), demonstrated BMD improvement over 12 months. Testosterone treatment for 6 months in dialysis-dependant men (n = 1 study) did not improve BMD. There is evidence that raloxifene treatment may be beneficial in improving BMD in post-menopausal women with CKD. There is insufficient evidence for other hormone treatments in men or women. Despite high fracture rates and frequent gonadal dysfunction in patients with CKD, significant evidence gaps exist, and well-designed studies are required to specifically assess the impact of gonadal status in the pathogenesis of CKD-related bone fragility and its treatment.
Collapse
Affiliation(s)
- Jasna Aleksova
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia.
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia.
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - Alexander J Rodriguez
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Bone & Muscle Health Research Group, Department of Medicine, Monash University, Melbourne, Australia
| | - Robert McLachlan
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter Kerr
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
29
|
Potassium Citrate Supplementation Decreases the Biochemical Markers of Bone Loss in a Group of Osteopenic Women: The Results of a Randomized, Double-Blind, Placebo-Controlled Pilot Study. Nutrients 2018; 10:nu10091293. [PMID: 30213095 PMCID: PMC6164684 DOI: 10.3390/nu10091293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022] Open
Abstract
The relationship involving acid-base imbalance, mineral metabolism and bone health status has previously been reported but the efficacy of the alkalizing supplementation in targeting acid overload and preventing bone loss has not yet been fully elucidated. In this randomized, double-blind, placebo-controlled study, the hypothesis that potassium citrate (K citrate) modifies bone turnover in women with postmenopausal osteopenia was tested. Three hundred and ten women were screened; 40 women met the inclusion criteria and were randomly assigned to the treatment or the placebo group. They were treated with K citrate (30 mEq day−1) or a placebo in addition to calcium carbonate (500 mg day−1) and vitamin D (400 IU day−1). At baseline and time points of 3 and 6 months, serum indicators of renal function, electrolytes, calciotropic hormones, serum bone turnover markers (BTMs) (tartrate-resistant acid phosphatase 5b (TRACP5b), carboxy-terminal telopeptide of type I collagen (CTX), bone alkaline phosphatase (BAP), procollagen type 1 N terminal propeptide (PINP)), and urine pH, electrolytes, and citrate were measured. The follow-up was completed by 17/20 patients in the “K citrate” group and 18/20 patients in the “placebo” group. At baseline, 90% of the patients exhibited low potassium excretion in 24 h urine samples, and 85% of cases had at least one urine parameter associated with low-grade acidosis (low pH, low citrate excretion). After treatment, CTX and BAP decreased significantly in both groups, but subjects with evidence of low-grade acidosis gained significant benefits from the treatment compared to the placebo. In patients with low 24h-citrate excretion at baseline, a 30% mean decrease in BAP and CTX was observed at 6 months. A significant reduction was also evident when low citrate (BAP: −25%; CTX: −35%) and a low pH (BAP: −25%; CTX: −30%) were found in fasting-morning urine. In conclusion, our results suggested that K citrate supplementation improved the beneficial effects of calcium and vitamin D in osteopenic women with a documented potassium and citrate deficit, and a metabolic profile consistent with low-grade acidosis.
Collapse
|
30
|
Bover J, Ureña-Torres P, Torregrosa JV, Rodríguez-García M, Castro-Alonso C, Górriz JL, Laiz Alonso AM, Cigarrán S, Benito S, López-Báez V, Lloret Cora MJ, daSilva I, Cannata-Andía J. Osteoporosis, bone mineral density and CKD-MBD complex (I): Diagnostic considerations. Nefrologia 2018; 38:476-490. [PMID: 29703451 DOI: 10.1016/j.nefro.2017.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/21/2017] [Accepted: 12/31/2017] [Indexed: 01/10/2023] Open
Abstract
Osteoporosis (OP) and chronic kidney disease (CKD) independently influence bone and cardiovascular health. A considerable number of patients with CKD, especially those with stages 3a to 5D, have a significantly reduced bone mineral density leading to a high risk of fracture and a significant increase in associated morbidity and mortality. Independently of classic OP related to age and/or gender, the mechanical properties of bone are also affected by inherent risk factors for CKD ("uraemic OP"). In the first part of this review, we will analyse the general concepts regarding bone mineral density, OP and fractures, which have been largely undervalued until now by nephrologists due to the lack of evidence and diagnostic difficulties in the context of CKD. It has now been proven that a reduced bone mineral density is highly predictive of fracture risk in CKD patients, although it does not allow a distinction to be made between the causes which generate it (hyperparathyroidism, adynamic bone disease and/or senile osteoporosis, etc.). Therefore, in the second part, we will analyse the therapeutic indications in different CKD stages. In any case, the individual assessment of factors which represent a higher or lower risk of fracture, the quantification of this risk (i.e. using tools such as FRAX®) and the potential indications for densitometry in patients with CKD could represent an important first step pending new clinical guidelines based on randomised studies which do not exclude CKD patients, all the while avoiding therapeutic nihilism in an area of growing importance.
Collapse
Affiliation(s)
- Jordi Bover
- Fundació Puigvert, Servicio de Nefrología, IIB Sant Pau, REDinREN, Barcelona, España.
| | - Pablo Ureña-Torres
- Ramsay-Générale de Santé, Clinique du Landy, Department of Nephrology and Dialysis and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, París, Francia
| | - Josep-Vicent Torregrosa
- Servicio de Nefrología, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Minerva Rodríguez-García
- Servicio de Nefrología, Hospital Universitario Central de Asturias, REDinREN, Universidad de Oviedo, Oviedo, España
| | | | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, España
| | | | | | - Silvia Benito
- Fundació Puigvert, Servicio de Nefrología, IIB Sant Pau, REDinREN, Barcelona, España
| | - Víctor López-Báez
- Fundació Puigvert, Servicio de Nefrología, IIB Sant Pau, REDinREN, Barcelona, España
| | | | - Iara daSilva
- Fundació Puigvert, Servicio de Nefrología, IIB Sant Pau, REDinREN, Barcelona, España
| | - Jorge Cannata-Andía
- Unidad de Gestión Clínica de Servicio de Metabolismo Óseo, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, REDinREN, Universidad de Oviedo, Oviedo, España
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW This review summarizes recent findings on musculoskeletal health in three chronic renal conditions of childhood: chronic kidney disease stages 2-5D, nephrotic syndrome, and urolithiasis. Findings with important clinical implications warranting further investigation are highlighted. RECENT FINDINGS Recent cohort studies have demonstrated a high burden of fracture and progressive deficits of cortical bone in children with chronic kidney disease. Lower cortical density is associated with incident fracture and may be an important therapeutic target. Parathyroid hormone and calcium are independent correlates of cortical density, and modifiable factors for fracture include parathyroid hormone and phosphate binder use. Children with nephrotic syndrome, even with normal renal function, have evidence of abnormal bone metabolism and structure, and vitamin D deficiency may be an important modifiable risk factor in this population. Urolithiasis has been associated with reduced bone mineral density and is increasingly common in children and adolescents. Population-based data found a significantly increased risk of fracture in adolescent males and young women. SUMMARY Recent findings substantiate concern regarding the particular vulnerability of the growing skeleton to chronic renal disease. Studies are needed to determine how to optimize assessment and management of bone health in children with these conditions, particularly in terms of calcium and vitamin D requirements, with the goal of improving childhood bone accrual for lifelong fracture prevention.
Collapse
|
32
|
Pan BL, Loke SS. Chronic kidney disease associated with decreased bone mineral density, uric acid and metabolic syndrome. PLoS One 2018; 13:e0190985. [PMID: 29320555 PMCID: PMC5761949 DOI: 10.1371/journal.pone.0190985] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/22/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The relationship between decreased bone mineral density (BMD) and chronic kidney disease (CKD) is controversial. The associations among metabolic syndrome (MetS), serum uric acid and CKD are also unclear. We aimed to investigate the relationship between decreased BMD, MetS, serum uric acid and CKD in a general population. METHODS A total of 802 subjects who visited a medical center in Southern Taiwan and underwent a BMD measured by dual-energy X-ray absorptiometry (DEXA) during a health examination were enrolled in this retrospective cross-sectional study. Either osteopenia or osteoporosis was defined as decreased BMD. CKD was defined as the estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2. Simple and multivariate logistic regression analyses were used to investigate the association between variables, decreased BMD and CKD. RESULTS Of the 802 subjects with a mean age of 54.4±10.2 years, the prevalence of decreased BMD was 62.9%, and CKD was 3.7%. Simple logistic analysis showed that sex (OR 3.50, 95% CI 1.21-10.12, p = 0.021), age (OR 1.14, 95% CI 1.07-1.21, p<0.001), BMI (OR 1.11, 95% CI 1.01-1.22, p = 0.028), waist circumference (OR 1.06, 95% CI 1.02-1.10, p = 0.002), SBP (OR 1.03, 95% CI 1.01-1.04, p = 0.003), DBP (OR 1.03, 95% CI 1.00-1.06, p = 0.030), HDL-C (OR 0.97, 95% CI 0.94-1.00, p = 0.026), uric acid (OR 1.84, 95% CI 1.49-2.27, p<0.001), metabolic syndrome (OR 2.68, 95% CI 1.29-5.67, p = 0.009), and decreased BMD (OR 3.998, 95% CI 1.38-11.57, p = 0.011) were significantly associated with CKD. Multivariate analysis showed that age (OR 1.05, 95% CI 1.03-1.07, p<0.001), decreased BMD (OR 0.64, 95% CI 0.45-0.91, p = 0.013), and uric acid (OR 1.40, 95% CI 1.24-1.59, p<0.001) were significantly independently associated with CKD. CONCLUSIONS Decreased BMD, uric acid and MetS were significantly associated with CKD.. Further large and prospective cohort studies are necessary to investigate whether management of osteoporosis, hyperuricemia, or MetS might prevent the progression of CKD.
Collapse
Affiliation(s)
- Bo-Lin Pan
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Niaosong District, Kaohsiung, Taiwan
| | - Song-Seng Loke
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Niaosong District, Kaohsiung, Taiwan
| |
Collapse
|
33
|
Dipstick Proteinuria and Reduced Estimated Glomerular Filtration Rate as Independent Risk Factors for Osteoporosis. Am J Med Sci 2017; 355:434-441. [PMID: 29753373 DOI: 10.1016/j.amjms.2017.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Osteoporosis is associated with a poor quality of life and mortality. Proteinuria contributes to vitamin D deficiency and osteoblast dysfunction. The correlation between estimated glomerular filtration rate (eGFR) and bone density still remains elusive. Therefore, we sought to investigate whether reduced eGFR or proteinuria are independently associated with the osteoporotic risk. METHODS We conducted a cross-sectional study using community-based health survey data from January 2004 to December 2008 in southern Taiwan. Positive proteinuria was defined as presence of 1+ or more urinary proteins on the dipstick. The bone density was measured by calcaneal quantitative ultrasound (QUS). Subjects with T-score ≤ -2.5 were considered as osteoporotic. RESULTS A total of 21,271 subjects of whom 11.3% had proteinuria were analyzed. Proteinuric participants were older, predominantly male, and more likely to have diabetes, hypertension, or exercise less regularly (P < 0.001). Multiple linear regression analysis showed that male sex, body mass index, regular exercise, eGFR and high density lipoprotein-cholesterol were positively correlated with QUS T-scores, whereas age, systolic blood pressure and proteinuria were negatively associated with QUS T-scores (P < 0.01). Compared with subjects in the highest eGFR tertile, those in the middle and the lowest groups had adjusted ORs for osteoporosis of 1.31 (95% CI: 1.20-1.44) and 2.46 (1.73-3.48), respectively. Additionally, the fully adjusted ORs of osteoporosis were 1.15 (1.02-1.32) and 1.18 (1.05-1.33) for participants with 1+ and ≥2+ proteinuria, respectively. CONCLUSIONS Reduced eGFR and proteinuria are significantly associated with risk for osteoporosis.
Collapse
|
34
|
Association between the age-related decline in renal function and lumbar spine bone mineral density in healthy Chinese postmenopausal women. Menopause 2017; 25:538-545. [PMID: 29257031 DOI: 10.1097/gme.0000000000001039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The relationship between the decline of renal function and bone mineral density (BMD) in healthy populations is not well-researched. The aim of this study was to investigate the association between the age-related decline in renal function and lumbar spine BMD (LBMD) in a community-based cross-sectional study of 390 healthy postmenopausal women (mean age 62.97 ± 8.79 years) from Shenyang, China. METHODS Dual-energy x-ray absorptiometry was used to measure LBMD. Estimated glomerular filtration rate (eGFR) was calculated using a modified Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for Asians and the CKD-EPI serum creatinine-cystatin c equation. Pearson's correlation analysis and binary logistic regression were used to evaluate associations. RESULTS The eGFR-ASIA and eGFR-Scys were positively correlated with LBMD (r = 0.120 and r = 0.108, respectively). After adjustments for numerous potential confounders, the odds ratio for participants with LBMD decline in eGFR-ASIA quartile 3 group and 4 group were 2.45 (95% confidence interval [CI] 1.12-5.38, P < 0.05) and 3.89 (95% CI 1.55-9.76, P < 0.01), respectively, with P = 0.003 for the trend in eGFR-ASIA compared with the lowest quartile 1 group of eGFR-ASIA, where the odds ratio of eGFR-Scys for the quartile of 3 and 4 groups were 2.47 (95% CI 1.09-5.62, P < 0.05) and 2.63 (95% CI 1.10-6.29, P < 0.05), respectively, with P = 0.016 for the trend in eGFR-Scys compared with the lowest quartile 1 group of eGFR-Scys. CONCLUSIONS The renal function decline was independently associated with decreased LBMD, and it was possible that the age-related decline in kidney function was an independent risk factor for decreased LBMD in healthy Chinese postmenopausal women.
Collapse
|
35
|
Malmgren L, McGuigan F, Christensson A, Akesson KE. Reduced kidney function is associated with BMD, bone loss and markers of mineral homeostasis in older women: a 10-year longitudinal study. Osteoporos Int 2017; 28:3463-3473. [PMID: 29038837 PMCID: PMC5684332 DOI: 10.1007/s00198-017-4221-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/06/2017] [Indexed: 01/06/2023]
Abstract
Kidney function decreases with age; however, the long-term influence on bone density (BMD) in older women already at risk of osteoporosis is unknown. We followed kidney function and bone loss for 10 years. Declining kidney function was adversely associated with bone loss and mineral homeostasis in old women, though it attenuated with advanced aging. INTRODUCTION Existing studies do not fully address the relationship between kidney function and bone metabolism with advanced aging in Caucasian women. This study describes the association between kidney function, BMD, bone loss and bone metabolism in older women and provides a review of the available literature for context. METHODS We studied participants from the OPRA cohort with follow-up after 5 and 10 years. Using plasma cystatin C (cysC), estimated glomerular function rate (eGFR) was evaluated at age 75 (n = 981), 80 (n = 685) and 85 (n = 365). Women were stratified into "normal" function (CKD stages 1-2), "intermediate" (stage 3a) and "poor" (stages 3b-5), and outcome measures-BMD, bone loss and markers of mineral homeostasis-were compared. RESULTS Femoral neck (FN) BMD positively associated with kidney function at 75 years old ([Formula: see text] = 0.001, p = 0.028) and 80 years old ([Formula: see text] = 0.001, p = 0.001), although with small effect size. Prevalence of osteoporosis (FN T-score ≤ - 2.5) did not differ with kidney function. Measured at age 75, women with poor kidney function had higher annual percentage bone loss over 5 years compared to those with normal function (2.3%, 95% CI 1.8-2.8 versus 1.3%, 95% CI 1.1-1.5, p = 0.007), although not when measured from age 80 or 85. Additionally, markers of mineral homeostasis (PTH, phosphate, vitamin D, calcium), CRP and osteocalcin differed by kidney function. CONCLUSIONS In old women, kidney function is associated with BMD, bone loss and altered mineral homeostasis; probably, a relationship attenuated in the very elderly.
Collapse
Affiliation(s)
- L Malmgren
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden
- Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden
| | - F McGuigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden
- Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden
| | - A Christensson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden
- Department of Nephrology, Skåne University Hospital, S-205 02, Malmö, Sweden
| | - K E Akesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden.
- Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden.
| |
Collapse
|
36
|
Granchi D, Torreggiani E, Massa A, Caudarella R, Di Pompo G, Baldini N. Potassium citrate prevents increased osteoclastogenesis resulting from acidic conditions: Implication for the treatment of postmenopausal bone loss. PLoS One 2017; 12:e0181230. [PMID: 28715463 PMCID: PMC5513456 DOI: 10.1371/journal.pone.0181230] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/28/2017] [Indexed: 12/19/2022] Open
Abstract
The extracellular acidic milieu in bones results in activation of osteoclasts (OC) and inhibition of osteoblasts (OB) causing a net loss of calcium from the skeleton and the deterioration of bone microarchitecture. Alkalinization through supplementation with potassium citrate (K citrate) has been proposed to limit the osteopenia progression, even though its pharmacological activity in bone microenvironment is not well defined. We evaluated if K citrate was able to prevent the adverse effects that acidic milieu induces on bone cells. OC and OB were maintained in neutral (pH 7.4) versus acidic (pH 6.9) culture medium, and treated with different K citrate concentrations. We evaluated the OC differentiation at seven days, by counting of multinucleated cells expressing tartrate-resistant acid phosphatase, and the activity of mature OC at 14 days, by quantifying of collagen degradation. To evaluate the effects on OB, we analyzed proliferation, mineralization, and expression of bone-related genes. We found that the low pH increased OC differentiation and activity and decreased OB function. The osteoclastogenesis was also promoted by RANKL concentrations ineffective at pH 7.4. Non-cytotoxic K citrate concentrations were not sufficient to steadily neutralize the acidic medium, but a) inhibited the osteoclastogenesis, the collagen degradation, and the expression of genes involved in RANKL-mediated OC differentiation, b) enhanced OB proliferation and alkaline phosphatase expression, whereas it did not affect the in vitro mineralization, and c) were effective also in OC cultures resistant to alendronate, i.e. the positive control of osteoclastogenesis inhibition. In conclusion, K citrate prevents the increase in OC activity induced by the acidic microenvironment, and the effect does not depend exclusively on its alkalizing capacity. These data provide the biological basis for the use of K citrate in preventing the osteopenia progression resulting from low-grade acidosis.
Collapse
Affiliation(s)
- Donatella Granchi
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
- * E-mail:
| | - Elena Torreggiani
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Annamaria Massa
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Gemma Di Pompo
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Nicola Baldini
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
37
|
Fink HA, Vo TN, Langsetmo L, Barzilay JI, Cauley JA, Schousboe JT, Orwoll ES, Canales MT, Ishani A, Lane NE, Ensrud KE. Association of Increased Urinary Albumin With Risk of Incident Clinical Fracture and Rate of Hip Bone Loss: the Osteoporotic Fractures in Men Study. J Bone Miner Res 2017; 32:1090-1099. [PMID: 28012217 PMCID: PMC5413394 DOI: 10.1002/jbmr.3065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/06/2016] [Accepted: 12/15/2016] [Indexed: 12/29/2022]
Abstract
Prior studies suggest that increased urine albumin is associated with a heightened fracture risk in women, but results in men are unclear. We used data from Osteoporotic Fractures in Men (MrOS), a prospective cohort study of community-dwelling men aged ≥65 years, to evaluate the association of increased urine albumin with subsequent fractures and annualized rate of hip bone loss. We calculated albumin/creatinine ratio (ACR) from urine collected at the 2003-2005 visit. Subsequent clinical fractures were ascertained from triannual questionnaires and centrally adjudicated by review of radiographic reports. Total hip BMD was measured by DXA at the 2003-2005 visit and again an average of 3.5 years later. We estimated risk of incident clinical fracture using Cox proportional hazards models, and annualized BMD change using ANCOVA. Of 2982 men with calculable ACR, 9.4% had ACR ≥30 mg/g (albuminuria) and 1.0% had ACR ≥300 mg/g (macroalbuminuria). During a mean of 8.7 years of follow-up, 20.0% of men had an incident clinical fracture. In multivariate-adjusted models, neither higher ACR quintile (p for trend 0.75) nor albuminuria (HR versus no albuminuria, 0.89; 95% CI, 0.65 to 1.20) was associated with increased risk of incident clinical fracture. Increased urine albumin had a borderline significant, multivariate-adjusted, positive association with rate of total hip bone loss when modeled in ACR quintiles (p = 0.06), but not when modeled as albuminuria versus no albuminuria. Macroalbuminuria was associated with a higher rate of annualized hip bone loss compared to no albuminuria (-1.8% more annualized loss than in men with ACR <30 mg/g; p < 0.001), but the limited prevalence of macroalbuminuria precluded reliable estimates of its fracture associations. In these community-dwelling older men, we found no association between urine albumin levels and risk of incident clinical fracture, but found a borderline significant, positive association with rate of hip bone loss. © 2016 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Howard A. Fink
- Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Tien N. Vo
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joshua I. Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Atlanta, GA
- Division of Endocrinology, Emory University School of Medicine, Atlanta, GA
| | - Jane A. Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - John T. Schousboe
- Park Nicollet Institute, Minneapolis, MN
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Eric S. Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR
| | - Muna T. Canales
- Department of Medicine (Nephrology), College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL
| | - Areef Ishani
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | - Kristine E. Ensrud
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| |
Collapse
|
38
|
Torres PAU, Cohen-Solal M. Evaluation of fracture risk in chronic kidney disease. J Nephrol 2017; 30:653-661. [PMID: 28386879 DOI: 10.1007/s40620-017-0398-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/29/2017] [Indexed: 01/09/2023]
Abstract
Chronic kidney disease (CKD) is associated with mineral and bone disorders (MBD) that are now considered as a syndrome. Bone fragility and a four to tenfold increased rate of skeletal fractures are often reported in CKD patients. The evaluation of the risk of these fractures in CKD patients should explore the same risk factors identified for the general population including low body weight, menopause, personal and familial history of osteoporosis, chronic inflammatory diseases, and corticosteroid therapy. The aim of this article is to provide a critical review of the tools used for the evaluation of bone loss and the risk of fracture in CKD patients, ranging from the measurement of bone mineral density (BMD), fracture risk assessment (Frax™), quantitative computed tomography (QCT), high-resolution peripheral quantitative computed tomography (HRpQTC), to circulating biomarkers of bone metabolism including vitamin D, parathyroid hormone (PTH), bone-specific alkaline phosphatase, osteocalcin, and some collagen type 1-related molecules indicators of bone remodeling.
Collapse
Affiliation(s)
- Pablo Antonio Ureña Torres
- Ramsay-Générale de Santé, Clinique du Landy, Saint-Ouen, France. .,Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France.
| | - Martine Cohen-Solal
- INSERM U1132 and USPC Paris-Diderot, Paris, France.,Department of Rheumatology, Hôpital Lariboisière, Paris, France
| |
Collapse
|
39
|
Kim CS, Bae EH, Ma SK, Han SH, Choi KH, Lee J, Chae DW, Oh KH, Ahn C, Kim SW. Association of Serum Osteoprotegerin Levels with Bone Loss in Chronic Kidney Disease: Insights from the KNOW-CKD Study. PLoS One 2016; 11:e0166792. [PMID: 27855207 PMCID: PMC5113973 DOI: 10.1371/journal.pone.0166792] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/03/2016] [Indexed: 11/18/2022] Open
Abstract
Osteoprotegerin, a potent osteoclast activation inhibitor, decreases bone resorption and positively affects bone mineral density. This study examined the association between serum osteoprotegerin levels and bone loss in patients with chronic kidney disease, a condition associated with increased risk of mineral and bone disorders. The bone mineral densities of the lumbar spine, total hip, and femur neck were assessed by dual-energy X-ray absorptiometry; serum osteoprotegerin levels were measured at baseline for 1,423 patients enrolled in the prospective KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD). Patients aged ≥50 years and with a T-score ≤ -2.5 were diagnosed as having osteoporosis. Multivariable linear regression analysis indicated independent association between serum osteoprotegerin levels and decreased bone mineral density in the lumbar spine (B: -0.489, 95% confidence interval [CI]: -0.883 to -0.095, P = 0.015), and total hip (B: -0.349, 95% CI: -0.672 to -0.027, P = 0.027). However, bone mineral density of the femur neck was not associated with serum osteoprotegerin levels in women. After adjustments, no independent association was found between serum osteoprotegerin levels and bone mineral density in men. In multivariable logistic regression analysis, serum osteoprotegerin levels were associated with increased risk of osteoporosis in women (odds ratio [OR]: 4.72, 95% CI: 1.35 to 16.52, P = 0.015), but not in men (OR: 0.21; 95% CI: 0.04 to 1.31, P = 0.095). To summarize, in female patients with chronic kidney disease, increased serum osteoprotegerin levels were independently associated with decreased bone mineral density in the lumbar spine and total hip, and with increased risk of osteoporosis. Therefore, the measurement of serum osteoprotegerin concentration might be useful as a surrogate marker for determining bone loss in patients with chronic kidney disease, especially for women, although not so much for men.
Collapse
Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hyeok Han
- Depatment of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Hun Choi
- Depatment of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Dong Wan Chae
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- * E-mail:
| | | |
Collapse
|
40
|
Lima GAC, de Paula Paranhos-Neto F, Silva LC, de Mendonça LMC, Delgado AG, Leite M, Gomes CP, Farias MLF. Bone Density Is Directly Associated With Glomerular Filtration and Metabolic Acidosis but Do Not Predict Fragility Fractures in Men With Moderate Chronic Kidney Disease. J Clin Densitom 2016; 19:146-53. [PMID: 24709549 DOI: 10.1016/j.jocd.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/22/2014] [Indexed: 01/10/2023]
Abstract
Hyperparathyroidism, vitamin D deficiency, increased fibroblast growth factor-23 (FGF-23), and metabolic acidosis promote bone fragility in chronic kidney disease (CKD). Although useful in predicting fracture risk in the general population, the role of dual-energy X-ray absorptiometry (DXA) in CKD remains uncertain. This cross-sectional study included 51 men aged 50-75 yr with moderate CKD. The stage 4 CKD patients had higher levels of parathyroid hormone (p<0.001), FGF-23 (p=0.029), and lowest 25-hydroxyvitamin D (p=0.016), bicarbonate (p<0.001), total femur (p=0.003), and femoral neck (p=0.011) T-scores compared with stage 3 CKD patients. Total femur and femoral neck T-scores were directly correlated with serum bicarbonate (p=0.003, r=0.447 and p=0.005, r=0.427, respectively) and estimated glomerular filtration rate (p=0.024, r=0.325 and p=0.003, r=0.313, respectively) but were not significantly associated with parathyroid hormone, 25-hydroxyvitamin D, or FGF-23. Only 3.9% of the participants had osteoporosis on DXA scan, whereas 31.4% reported a low-impact fracture. Our data point to a pivotal role of metabolic acidosis for bone impairment and to the inadequacy of DXA to evaluate bone fragility in CKD patients.
Collapse
Affiliation(s)
- Guilherme Alcantara Cunha Lima
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil.
| | - Francisco de Paula Paranhos-Neto
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Luciana Colonese Silva
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Laura Maria Carvalho de Mendonça
- Division of Rheumatology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Alvimar Gonçalves Delgado
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Maurilo Leite
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Carlos Perez Gomes
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Maria Lucia Fleiuss Farias
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| |
Collapse
|
41
|
Kuipers AL, Egwuogu H, Evans RW, Patrick AL, Youk A, Bunker CH, Zmuda JM. Renal Function and Bone Loss in a Cohort of Afro-Caribbean Men. J Bone Miner Res 2015; 30:2215-20. [PMID: 26011289 PMCID: PMC4775470 DOI: 10.1002/jbmr.2562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/08/2015] [Accepted: 05/15/2015] [Indexed: 11/11/2022]
Abstract
Poor renal function is associated with increased rates of bone loss and osteoporotic fractures in Caucasian men. The importance of kidney function for skeletal health in African ancestry men, who are a population segment with a high prevalence of chronic kidney disease as well as high peak bone mass, is not well known. We examined the relationship between estimated glomerular filtration rate (eGFR) and rates of bone loss in a large population cohort of otherwise healthy Afro-Caribbean men aged 40 years and older. Dual X-ray absorptiometry of the proximal femur and quantitative computed tomography of the proximal radius and tibia were obtained approximately 6 years apart. We calculated eGFR from serum creatinine that was measured in fasting samples in 1451 men. Impaired kidney function (IKF, eGFR<60 ml/min/1.7 m(2)) was observed in 8.6% of the cohort. The relationship between IKF and baseline BMD and annualized rate of change in BMD was analyzed controlling for potentially important confounders. IKF was not associated with baseline BMD. In contrast, men with IKF experienced a rate of decline in areal BMD at the total hip, femoral neck and trochanter and cortical volumetric BMD compared to those with normal kidney function (p<0.05 for all). Impaired kidney function was not associated with changes in trabecular volumetric BMD. In conclusion, poorer kidney function is associated with accelerated bone loss among otherwise healthy Afro-Caribbean men even after controlling for age and other important medical and lifestyle related variables.
Collapse
Affiliation(s)
- Allison L Kuipers
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heartley Egwuogu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rhobert W Evans
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alan L Patrick
- The Tobago Health Studies Office, Scarborough, Tobago, Trinidad & Tobago
| | - Ada Youk
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clareann H Bunker
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
42
|
Sheng YH, Chen JH, Chiou JM, Tsai KS, Lee YY, Tsao CK, Chen YC. Association of Renal Function and Menopausal Status with Bone Mineral Density in Middle-aged Women. Sci Rep 2015; 5:14956. [PMID: 26459876 PMCID: PMC4602276 DOI: 10.1038/srep14956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/14/2015] [Indexed: 11/16/2022] Open
Abstract
The association between mild renal dysfunction and bone mineral density (BMD) has not been fully explored. It is also unclear how menopausal status and the use of Chinese herb affect this association. This is a cross-sectional study that included a total of 1,419 women aged 40 to 55 years old who were recruited from the MJ Health Management Institution in Taiwan between 2009 and 2010. Spinal BMD was assessed by dual-energy X-ray absorptiometry. Renal function was assessed using estimated glomerular filtration rate (eGFR) and creatinine clearance rate (CCr). The multivariable logistic regression and general linear models were employed to assess the association between renal function and BMD. Stratification analyses were performed by menopausal status and use of Chinese herbs. Low CCr levels were significantly associated with low BMD [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.15–1.90]. This association was observed in premenopausal women (AOR = 1.43, 95% CI = 1.07–1.92) and in women not taking Chinese herbs (AOR = 1.48, 95% CI = 1.14–1.94). CCr is a better predictor for low BMD in middle-aged women. Menopausal status and the use of Chinese herbs also affected this association.
Collapse
Affiliation(s)
- Yueh-Hsuan Sheng
- Department of Family Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeng-Min Chiou
- Institute of Statistical Science Academia Sinica, Taipei, Taiwan
| | - Keh-Sung Tsai
- Department of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yue-Yuan Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, Taipei, Taiwan.,Research Center for Genes, Environment and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
43
|
Babayev R, Nickolas TL. Bone Disorders in Chronic Kidney Disease: An Update in Diagnosis and Management. Semin Dial 2015; 28:645-53. [DOI: 10.1111/sdi.12423] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Revekka Babayev
- Department of Medicine; Division of Nephrology; Columbia University Medical Center; New York City New York
| | - Thomas L. Nickolas
- Department of Medicine; Division of Nephrology; Columbia University Medical Center; New York City New York
| |
Collapse
|
44
|
Isakova T, Craven TE, Scialla JJ, Nickolas TL, Schnall A, Barzilay J, Schwartz AV. Change in estimated glomerular filtration rate and fracture risk in the Action to Control Cardiovascular Risk in Diabetes Trial. Bone 2015; 78:23-7. [PMID: 25937184 PMCID: PMC4466209 DOI: 10.1016/j.bone.2015.04.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/15/2015] [Accepted: 04/23/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Patients with type 2 diabetes (T2DM) are at increased risk of fracture. High prevalence of chronic kidney disease (CKD) in T2DM may contribute to bone fragility, but whether dynamic change in kidney function is associated with fracture risk is unclear. RESEARCH DESIGN AND METHODS To evaluate the association of pre-randomization baseline estimated glomerular filtration (eGFR) and its change over time with subsequent fracture risk in the Bone substudy of Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, we conducted an observational study of 2262 women and 4737 men with T2DM and with at least 2 eGFR values. RESULTS During a mean follow-up of 4.40±1.54 years, 235 women and 223 men sustained a new non-vertebral fracture. In multivariable adjusted sex-specific models, pre-randomization baseline eGFR was not a significant predictor of fracture risk in either men or women. However, a steeper decline in eGFR was associated with greater risk of fracture in women (hazard ratio [HR] per standard deviation [SD] decrement in eGFR slope, 1.30; 95% CI 1.17-1.44) but not men (HR per SD decrement in eGFR slope, 0.97; 95%CI 0.82-1.13). Accounting for competing risk of death modestly attenuated the association in women (HR per SD decrement in eGFR slope, 1.19; 95% CI 1.04-1.37), with the relationship in men remaining non-significant (HR per SD decrement in eGFR slope, 0.96; 95% CI 0.77-1.18). CONCLUSIONS Declining kidney function predicts fracture risk in women but not in men with T2DM. Future studies should investigate the mechanisms for these associations.
Collapse
Affiliation(s)
- Tamara Isakova
- Department of Medicine, Division of Nephrology, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Timothy E Craven
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Julia J Scialla
- Department of Medicine, Division of Nephrology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Thomas L Nickolas
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Adrian Schnall
- University Suburban Health Center, South Euclid, OH, USA
| | - Joshua Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia and Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
45
|
Denburg MR, Kumar J, Jemielita T, Brooks ER, Skversky A, Portale AA, Salusky IB, Warady BA, Furth SL, Leonard MB. Fracture Burden and Risk Factors in Childhood CKD: Results from the CKiD Cohort Study. J Am Soc Nephrol 2015; 27:543-50. [PMID: 26139439 DOI: 10.1681/asn.2015020152] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/29/2015] [Indexed: 12/30/2022] Open
Abstract
Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter. We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponding to 395 (95% confidence interval [95% CI], 293-533) and 323 (95% CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2- to 3-fold higher than published general population rates. The only gender difference in fracture risk was a 2.6-fold higher risk in males aged ≥15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P≤0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95% CI, 0.15-0.91; P=0.03). Participation in more than one team sport was associated with higher risk (hazard ratio, 4.87; 95% CI, 2.21-10.75; P<0.001). In conclusion, children with CKD have a high burden of fracture. Regarding modifiable factors, higher average parathyroid hormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.
Collapse
Affiliation(s)
- Michelle R Denburg
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Juhi Kumar
- Weill Cornell Medical College, New York, New York
| | - Thomas Jemielita
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen R Brooks
- Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy Skversky
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Anthony A Portale
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Isidro B Salusky
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bradley A Warady
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and
| | - Susan L Furth
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary B Leonard
- Stanford University School of Medicine, Stanford, California
| |
Collapse
|
46
|
LeBlanc ES, Rosales AG, Balasubramanian A, O'Malley CD, Egbuna O, Friess D, Perrin NA. Risk factors for fracture among current, persistent users of bisphosphonates. Osteoporos Int 2015; 26:713-25. [PMID: 25354654 DOI: 10.1007/s00198-014-2941-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/16/2014] [Indexed: 01/22/2023]
Abstract
SUMMARY Bisphosphonate therapy reduces fracture risk but does not eliminate fracture occurrence. We determined the fracture incidence and risk factors for fractures among 14,674 bisphosphonate users in a community setting. Bisphosphonate users remained at risk of fracture, and additional measures to prevent fractures in these patients would be beneficial. INTRODUCTION Bisphosphonate therapy reduces but does not eliminate fracture occurrence. The incidence of fracture and risk factors for fractures among persistent, current users of bisphosphonates in a community setting have not been well studied. METHODS We conducted a retrospective cohort study of 14,674 bisphosphonate users in a health maintenance organization. Patients were followed until a 3-month gap in therapy, creating a pool of highly compliant [mean medication possession ratio (MPR) of 94%] current users. We used Cox proportional hazards models to identify risk factors for fractures among these persistent, current users. RESULTS There were 867 fractures over the period of observation or 3.7 fractures per 100 users per year. Older patients who take multiple medications, have lower bone mineral density, have a history of prior fracture, and suffer from particular comorbidities (i.e., dementia, chronic kidney disease, and rheumatoid arthritis) are at higher risk of fracture while taking bisphosphonates. CONCLUSION Persistent, current bisphosphonate users remain at risk of fracture, and additional measures to prevent fractures in these patients would be of benefit.
Collapse
Affiliation(s)
- E S LeBlanc
- Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA,
| | | | | | | | | | | | | |
Collapse
|
47
|
Tseng CH, Huang WS, Li TC, Chen HJ, Muo CH, Kao CH. Increased risk of end-stage renal disease among hip fracture patients. Eur J Intern Med 2014; 25:956-61. [PMID: 25468738 DOI: 10.1016/j.ejim.2014.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/11/2014] [Accepted: 10/21/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Inflammation-related microvasculr disease, albuminuria, and rapid deterioration of renal function can accelerate the development of end-stage renal disease (ESRD). The role of hip fracture (HFr), a disorder that involves inflammation, in the development of ESRD has not been fully investigated. This study explored whether HFr increases the risk of ESRD. METHODS Taiwan National Health Insurance inpatient claims were used to identify 83,550 patients newly diagnosed with HFr from 2000 to 2006, and 83,550 age- and sex-matched patients without HFr were randomly selected for comparison. Hazards of ESRD combined with HFr, comorbidities, including hypertension, hyperlipidemia, peripheral arterial disease, osteoporosis and asthma, and general health status, with Charlson comorbidity index (CCI), were assessed using data to the end of 2011. RESULTS ESRD risk was 1.42-fold higher (95% confidence interval [CI]:1.29-1.33) in the HFr cohort than in the control group, which was computed using the Cox proportional model. Age-specific analysis revealed that the adjusted hazard ratios (aHRs) of ESRD for HFr patients increased slightly as age increased, with an aHR of 1.56 (95% CI:1.35-1.81) for patients 65-74 years old, which gradually decreased to 0.88 (95% CI:0.66-1.18) for patients ≥ 85 years old. ESRD risk increased as HFr severity increased, with an aHR of 6.71 (95% CI:5.90-7.63) for patients with severe HFr. CONCLUSION This study is the first to report that HFr, in combination with underlying osteoporosis-related chronic illness, microvascular disease and chronic inflammation, is associated with an increased risk of ESRD, particularly among relatively younger people.
Collapse
Affiliation(s)
- Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Shih Huang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
48
|
|
49
|
Roza T, Hakim L, van Poppel H, Joniau S. Bone-targeted therapies for elderly patients with renal cell carcinoma: current and future directions. Drugs Aging 2014; 30:877-86. [PMID: 24072355 DOI: 10.1007/s40266-013-0117-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bone metastases are very common in advanced renal cell carcinoma (RCC) and can have a huge impact on quality of life by leading to skeletal-related events (SREs), including pain, pathologic fractures and spinal cord compression with need for surgery or radiotherapy. Because of their osteolytic aspect and biologic behaviour, these SREs are more common in patients with bone metastases from RCC than from other malignancies. As overall survival is increased by new anti-angiogenic drugs like tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors, the incidence of SREs is rising, making the clinical management of bone metastases in RCC ever more important, especially in the more vulnerable elderly patient. In this review we discuss the current advances and future directions in bone-targeted therapies in patients with RCC with a special focus on the elderly population. Recently, two bone-targeted agents have been approved in the prevention of SREs in advanced RCC: zoledronic acid and denosumab. To date, there is no specific data on the use of bisphosphonates or denosumab in the elderly and specific studies in this setting are warranted. We compare the available evidence for the use and implications of both agents in the elderly patient and give general information on safety concerns that could be more important in these patients.
Collapse
Affiliation(s)
- Thomas Roza
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
| | | | | | | |
Collapse
|
50
|
Jung YS, Hwang HJ, Yun BH, Chon SJ, Cho S, Choi YS, Kim YT, Lee BS, Seo SK. Renal function is associated with bone mineral density and arterial stiffness in healthy postmenopausal women. Gynecol Obstet Invest 2014; 78:124-9. [PMID: 25034396 DOI: 10.1159/000363746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 05/18/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS This study aimed to investigate the effect of renal function on bone mineral density (BMD) and arterial stiffness in postmenopausal women. METHODS This is a retrospective cross-sectional study. We studied 252 postmenopausal women who visited a health promotion center for a medical checkup. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault (CG) formula and the modification of diet in renal disease (MDRD) formula. Areal BMD measurements were performed using dual-energy X-ray absorptiometry, and arterial stiffness was measured using the brachial-ankle pulse wave velocity (baPWV). RESULTS The eGFR according to the CG formula was significantly correlated with age, BMI, follicle-stimulating hormone, thyroid-stimulating hormone, high-density lipoprotein cholesterol, baPWV, and BMD at the lumbar spine, femoral neck, and total hip sites. However, the eGFR according to the MDRD formula was significantly correlated with age and baPWV but not with BMD at the lumbar spine, femoral neck, and total hip sites. Decreased renal function (eGFR <60 ml/min/1.73 m(2) according to the CG formula) was independently associated with decreased BMD at the femoral neck site and with increased baPWV (>1,500 cm/s) after adjusting for confounding variables. CONCLUSION Postmenopausal women with decreased renal function are more likely to have a decreased BMD and greater arterial stiffness.
Collapse
Affiliation(s)
- Yeon Soo Jung
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital Goyang, Goyang, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|