Evaluation of bone densitometry by dual-energy x-ray absorptiometry as a fracture prediction tool in women with chronic kidney disease. Bone reports BACKGROUND:The 2017 KDIGO guidelines establish a 2B grade recommendation in favor of testing Bone Mineral Density (BMD) by DXA to assess osteoporotic fracture (OPF) risk in patients with CKD G3a-G5D. Still, controversy remains because large studies evaluating it for this particular population are lacking. AIM:To establish the clinical performance of BMD measured by DXA in the evaluation of fracture risk in women with CKD. METHODS:We conducted a 43 year retrospective cohort study with 218 women ≥18 years-old with CKD and BMD measurement by DXA of total hip and lumbar spine. Clinical (age, year of CKD onset, comorbidities, BMI, transplant status, treatment), and biochemical (PTH, corrected calcium, phosphate, vitamin D [25 (OH) D3], creatinine, and albumin), parameters were collected from hospital records. All osteoporotic fractures (as defined by the WHO) found in the clinical and radiologic files were registered. RESULTS:218 women with a median age of 60 years (40-73 IQ range) and a CKD evolution time of 12 years (7-18 IQ range) were evaluated. Forty-eight (28.23%) presented an OPF. These women were older (57 vs 69 years,  =0.0072) and had a lower BMD. CKD stage did not influence fracture incidence. In the multivariate analysis we found that for each standard deviation decrease in hip and lumbar spine T-Score, the overall fracture risk was 2.7 and 2.04 times higher, respectively. More than 50% of fractures took place within the first ten years of follow-up, especially with GFR <30 mL/min/m and osteoporosis. Diabetes and hypothyroidism accelerated fracture onset, while renal transplant delayed it. In the ROC analysis, the AUC was largest with the total hip (0.7098,   ) and lumbar spine (0.6916,  = 0). CONCLUSIONS:BMD measured by DXA is a useful fracture prediction tool for women with CKD, having a sensibility and specificity similar to that in the general population. It seems to be appropriate for the diagnosis, treatment decisions, and follow-up of patients with renal failure. 10.1016/j.bonr.2020.100298

Relationship between bone mineral density and moderate to severe chronic kidney disease among general population in Korea. Myong Jun-Pyo,Kim Hyoung-Ryoul,Koo Jung-Wan,Park Chung Yill Journal of Korean medical science Recent studies in Western countries have reported a significant association between glomerular filtration rate (GFR) and bone mineral density (BMD) in the absence of dialysis among the general population. However, there have been few studies regarding renal function and BMD among Korean or Asian subjects with moderate to severe (stage 3 or 4) chronic kidney disease (MS-CKD). The aim of the present study was to investigate the association between MS-CKD and BMD in the general Korean population. BMD, serum creatinine and other measures were obtained from 3,190 subjects (1,428 males and 1,762 females; the fourth Korean National Health and Nutrition Examination Survey). GFR was estimated using the Cockcroft-Gault formula, with adjustment for body surface area. After adjustment for all variables, multiple regression analysis showed that BMD in the femur neck, total femur and lumbar spine were positively associated with eGFR in both males and females. Additional analysis showed that MS-CKD was also significantly associated with osteoporosis in both males and females (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.15-4.20 in males; and OR 1.96, 95% CI 1.33-2.88 in females). Individuals with MS-CKD may be at higher risk of osteoporosis even among Asians. 10.3346/jkms.2013.28.4.569

The correlation between renal function and bone mineral density. Tseng T -H,Mu C -F,Hsu C -Y Minerva urologica e nefrologica = The Italian journal of urology and nephrology AIM:The moderate, severe chronic kidney disease (CKD) and end stage renal disease (ESRD) are well-recognized risk factors of bone loss. However, it is uncertain whether mild CKD stage affects bone mineral density (BMD). The objective of this study is to investigate whether mild and/or more severe reduction of GFR is associated with BMD decreasing. METHODS:Between April and November 2011, 305 patients were included in this study. Estimated glomerular filtration rate (GFR) was calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. According to the GFR, we divided the participants into 3 groups: CKD stage I, stage II and stage ≥III. BMD was compared between different groups. RESULTS:Eighty-one women and 65 men were enrolled in the final study. The average age was 65.6. According to the eGFR, 54 (37.0%), 70 (47.9%) and 22 (15.1%) participants were classified into CKD stage I, II and ≥III, respectively. The mean T-score was -1.351±1.879.A significant bone loss was found in the stage ≥III group, especially in women (P<0.05). BMD decreasing was found significantly in male participants with CKD stage II (P=0.041). CONCLUSION:BMD significantly decreased in men with mild renal dysfunction. A significant BMD decreasing was also found in the group of CKD stage ≥III, especially in women. We suggest osteoporosis screening is necessary in patients with poor renal function.

Total and bone-specific alkaline phosphatase are associated with bone mineral density over time in end-stage renal disease patients starting dialysis. Bergman Annelie,Qureshi Abdul Rashid,Haarhaus Mathias,Lindholm Bengt,Barany Peter,Heimburger Olof,Stenvinkel Peter,Anderstam Björn Journal of nephrology BACKGROUND:Alkaline phosphatase (ALP) and bone-specific ALP (BALP) are implicated in the abnormal skeletal mineralization and accelerated vascular calcification in chronic kidney disease (CKD) patients. Whereas ALP and BALP may predict mortality in CKD, BALP is reported to have higher sensitivity and specificity than total ALP in reflecting histological alterations in bone; however, results on their associations with bone mineral density (BMD) are inconsistent. Here we evaluated associations of total ALP and BALP with BMD during up to 24 months in end-stage renal disease (ESRD) patients. METHODS:In this longitudinal study, 194 ESRD patients (median age 57 years, 66 % male, 32 % diabetes mellitus, mean body mass index 24.8 kg/m) underwent measurements of total ALP and BALP and total and regional body BMD (by dual-energy X-ray absorptiometry) at dialysis initiation (n = 194), and after 12 (n = 98) and 24 months (n = 40) on dialysis. RESULTS:At baseline, patients had median total ALP 65.4 (43.3-126.4) U/l, BALP 13.5 (7.1-27.3) µg/l and BMD 1.14 (0.97-1.31) g/cm. During the study period, serum concentrations of ALP and BALP increased significantly (p < 0.001), whereas total and regional BMD remained stable. BMD correlated inversely with total ALP (rho = -0.20, p = 0.005) and BALP (rho = -0.30, p < 0.001) at baseline, and correlations were similar also at 12 and 24 months. CONCLUSION:ALP and BALP are equally accurate albeit weak predictors of BMD in ESRD patients, both at baseline and longitudinally. The dissociation between stable BMD and increasing ALP and BALP may possibly reflect increased soft tissue calcifications with time on dialysis. 10.1007/s40620-016-0292-7