1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
Int Urol Nephrol. 2011 Jun;43(2):475-82. doi: 10.1007/s11255-010-9723-x. Epub 2010 Mar 18.
The incidence of fractures is substantially increased in patients with chronic kidney disease (CKD) compared to the general population. The factors associated with increased bone fracture in this population are not well understood. Vitamin D deficiency has been associated with decreased bone mass and higher incidence of fractures in the general population. In this study, we aimed to assess the association between fracture and vitamin D status and other factors potentially associated with fracture in patients on maintenance hemodialysis.
One hundred and forty-four patients were assessed and interviewed about previous low-trauma fractures. Evidence of fracture was obtained from medical records and also through patient interviews. Routine laboratory results were collected from medical records. Serum intact PTH (iPTH) and 25(OH) vitamin D(3) were measured. All patients underwent bone densitometry of the lumbar spine, femoral neck and distal radius. Bone quality was also assessed with quantitative bone ultrasound (QUS). Descriptive statistics, logistic regression models were used to analyze factors associated with fractures.
One hundred and thirty patients were included in the final analysis. Patients with fractures (n = 21) had lower 25(OH) vitamin D(3) levels (15.8 nmol/l (interquartile range, IQR: 27) vs. 30.0 nmol/l (IQR: 28.5), P = 0.029), were more likely females, had longer duration of end-stage kidney disease, and lower bone mineral density (BMD) at the distal radius. QUS parameters were not associated with fractures. Multivariate analyses revealed that serum 25(OH) vitamin D(3) concentration, BMD at the radius, iPTH less than 100 pg/ml and history of fractures were independent predictors of new bone fracture after the initiation of dialysis therapy.
Increased bone fragility in dialysis patients is associated with vitamin D deficiency and relative hypoparathyroidism in addition to reduced BMD at the radius. Further studies are needed to determine whether patients with vitamin D deficiency benefit from vitamin D supplementation to reduce fracture risk.
与普通人群相比，慢性肾脏病（CKD）患者的骨折发病率显著增加。该人群中与骨折风险增加相关的因素尚不清楚。维生素 D 缺乏与普通人群中骨量减少和骨折发生率增加有关。在这项研究中，我们旨在评估维持性血液透析患者骨折与维生素 D 状态及其他潜在骨折相关因素之间的关系。
对 144 名患者进行评估并询问其既往低创伤性骨折情况。通过病历和患者访谈获取骨折证据。从病历中收集常规实验室结果。测量血清全段甲状旁腺素（iPTH）和 25（OH）维生素 D（3）。所有患者均接受腰椎、股骨颈和桡骨远端骨密度测定。还使用定量骨超声（QUS）评估骨质量。采用描述性统计、逻辑回归模型分析与骨折相关的因素。
最终有 130 名患者纳入最终分析。骨折组（n=21）患者 25（OH）维生素 D（3）水平较低（15.8 nmol/L（四分位间距 IQR：27）比 30.0 nmol/L（IQR：28.5），P=0.029），更可能为女性，CKD 病程更长，桡骨远端骨密度较低。QUS 参数与骨折无关。多变量分析显示，血清 25（OH）维生素 D（3）浓度、桡骨骨密度、iPTH<100pg/ml 和骨折史是透析治疗开始后新发骨折的独立预测因素。
除桡骨骨密度降低外，透析患者的骨脆性增加还与维生素 D 缺乏和相对甲状旁腺功能减退症有关。需要进一步研究以确定维生素 D 缺乏的患者是否受益于维生素 D 补充以降低骨折风险。
Zotero 插件