Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy.
Osteoporos Int. 2017 Feb;28(2):577-584. doi: 10.1007/s00198-016-3770-9. Epub 2016 Sep 28.
In hemodialysis patients, vertebral fractures were associated with elevated sclerostin levels, suggesting that sclerostin could reflect bone fragility in these patients.
Fragility fractures are common in hemodialysis patients. The aims of our study were to determine the prevalence of vertebral fracture and analyze associations between sclerostin serum levels and vertebral fractures in hemodialysis patients.
Ninety-two hemodialysis patients and 100 controls matched for age and sex were studied. Bone mineral density was measured by ultrasonography at non-dominant heel. The markers of bone turnover included serum osteocalcin, C-terminal telopeptide, and sclerostin. All participants underwent radiography of the thoracic and lumbar spine to ascertain the presence of vertebral fractures.
Bone ultrasound parameters at calcaneus were significantly lower in hemodialysis patients compared with controls; bone turnover markers and parathyroid hormone level were significantly higher, while serum of 25-OH-D3 was significantly lower in hemodialysis group. One or more moderate or severe vertebral fractures were found in 38 hemodialysis patients, whereas in control group, 10 patients had a vertebral fracture. In hemodialysis group, the comparison between patients with and without vertebral fractures showed that the patients with vertebral fractures had the serum sclerostin levels statistically higher than patients without vertebral, while serum levels of 25-OH-D3 was significantly lower in patients with vertebral fractures compared to the patients without vertebral fractures. Multivariate analysis disclosed that sclerostin levels were associated with an increased risk of vertebral fractures in hemodialysis patients after adjusting for multiple variables.
Our data shows high prevalence of vertebral fractures in hemodialysis patients and that it is associated with elevated sclerostin levels, reflecting bone fragility in these patients.
在血液透析患者中，椎体骨折与升高的硬化素水平相关，表明硬化素可能反映这些患者的骨骼脆弱性。
脆性骨折在血液透析患者中很常见。我们的研究目的是确定椎体骨折的患病率，并分析硬化素血清水平与血液透析患者椎体骨折之间的关系。
研究纳入了 92 名血液透析患者和 100 名年龄和性别匹配的对照者。通过非优势侧脚跟超声测定骨矿物质密度。骨转换标志物包括血清骨钙素、C 端肽和硬化素。所有参与者均接受了胸椎和腰椎的 X 线摄影，以确定是否存在椎体骨折。
与对照组相比，血液透析患者的跟骨超声参数显著降低；骨转换标志物和甲状旁腺激素水平显著升高，而血清 25-羟维生素 D3 水平显著降低。38 名血液透析患者中发现 1 个或多个中度或重度椎体骨折，而对照组中有 10 名患者发生了椎体骨折。在血液透析组中，比较有和无椎体骨折的患者，发现有椎体骨折的患者血清硬化素水平显著高于无椎体骨折的患者，而有椎体骨折的患者血清 25-羟维生素 D3 水平显著低于无椎体骨折的患者。多变量分析显示，在校正多个变量后，硬化素水平与血液透析患者椎体骨折的风险增加相关。
我们的数据显示，血液透析患者椎体骨折的患病率较高，且与升高的硬化素水平相关，反映了这些患者的骨骼脆弱性。
