Aging Section, Consiglio Nazionale delle Ricerche (CNR)-Institute of Neuroscience, Via Giustiniani, 2, 35128, Padua, Italy.
Calcif Tissue Int. 2013 Jul;93(1):39-47. doi: 10.1007/s00223-013-9722-x. Epub 2013 Mar 14.
Few studies have provided information on the prevalence of vertebral fractures (VFs) and their risk factors in hemodialysis patients. A multicenter, cross-sectional, observational study was carried out to assess the prevalence of VFs and vascular calcifications (VCs) in 387 hemodialysis patients (mean age 64.2 ± 14.1 years, 63 % males) and in a control group of 51 osteoporotic subjects. Biochemical tests included 25(OH) vitamin D, bone Gla protein (total and undercarboxylated), and total matrix Gla protein. Vertebral quantitative morphometry was carried out centrally for the detection of VF, defined as reduction by ≥20 % of one of the vertebral body dimensions. In the same radiograph, aortic and iliac VC scores were calculated. Prevalence of VF was 55.3 % in hemodialysis patients and 51.0 % in the control group. Multivariate analysis disclosed that male gender (59.8 vs. 47.6 %, p = 0.02; OR = 1.78, 95 % CI 1.15-2.75) and age (mean ± SD 66.7 ± 13.1 vs. 61.0 ± 14.7 years, p < 0.001; OR = 1.03, 95 % CI 1.01-1.05) were significantly associated with VF. The prevalence of aortic VC was significantly higher in hemodialysis patients than in controls (80.6 vs. 68.4 %, p = 0.001). The factors with the strongest association with VC, apart from atrial fibrillation, were serum 25(OH)vitamin D levels below 29 ng/mL for aortic VC (OR = 1.85, 95 % CI 1.04-3.29) and VF both for aortic (OR = 1.77, 95 % CI 1.00-3.14) and iliac (OR = 1.96, 95 % CI 1.27-3.04) VC. In conclusion, the prevalence of VF, especially in males, and VC, in both genders, is high in hemodialysis patients. VF is associated with VC. Vitamin D deficiency is also associated with VC. Further longitudinal studies are warranted to investigate fractures in renal patients.
很少有研究提供关于血液透析患者椎体骨折（VF）及其危险因素的信息。一项多中心、横断面、观察性研究评估了 387 名血液透析患者（平均年龄 64.2±14.1 岁，63%为男性）和 51 名骨质疏松症患者的 VF 和血管钙化（VC）的发生率。生化检查包括 25（OH）维生素 D、骨 Gla 蛋白（总蛋白和非羧化蛋白）和总基质 Gla 蛋白。通过中央定量形态计量学检测 VF，定义为一个椎体尺寸减少≥20%。在同一张 X 光片上，计算了主动脉和髂骨 VC 评分。血液透析患者 VF 的发生率为 55.3%，对照组为 51.0%。多变量分析显示，男性（59.8%比 47.6%，p=0.02；OR=1.78，95%CI 1.15-2.75）和年龄（平均±标准差 66.7±13.1 比 61.0±14.7 岁，p<0.001；OR=1.03，95%CI 1.01-1.05）与 VF 显著相关。与对照组相比，血液透析患者的主动脉 VC 发生率明显更高（80.6%比 68.4%，p=0.001）。除房颤外，与 VC 相关性最强的因素是血清 25（OH）维生素 D 水平低于 29ng/mL 与主动脉 VC（OR=1.85，95%CI 1.04-3.29）和 VF （OR=1.77，95%CI 1.00-3.14）以及髂骨 VC（OR=1.96，95%CI 1.27-3.04）均相关。总之，血液透析患者，尤其是男性，以及男女两性的 VC 发生率均较高。VF 与 VC 相关。维生素 D 缺乏也与 VC 相关。需要进一步的纵向研究来调查肾脏患者的骨折情况。
