Aleksova Jasna, Wong Phillip, Mulley William R, Choy Kay Weng, McLachlan Robert, Ebeling Peter R, Kerr Peter G, Milat Frances
Department of Endocrinology, Monash Health, Melbourne, Australia.
Hudson Institute for Medical Research, Clayton, Melbourne, Australia.
Clin Endocrinol (Oxf). 2017 Aug;87(2):141-148. doi: 10.1111/cen.13363. Epub 2017 Jun 1.
Increased fracture rates are observed in renal transplant recipients (RTRs) compared with the general population. Risk factors include age, diabetes, dialysis vintage, immunosuppression and mineral and bone disorders. Low serum phosphorus levels occur post-transplantation; however, its relationship with fracture risk has not been evaluated. The purpose of this study was to evaluate risk factors for fracture in RTRs at a single tertiary referral centre.
A retrospective cross-sectional analysis of 146 patients (75 M, 71 F) who had been referred for dual energy X-ray densitometry (DXA) post-renal transplantation was performed. Aetiology of end stage kidney disease (ESKD), duration of dialysis, parathyroidectomy history, immunosuppression regimen, bone mineral density (BMD), biochemistry and fractures were documented. Statistical analyses included univariable and multivariable regression.
The mean age of patients was 54 years and mean time post-transplantation 6.7 years. A total of 79 fractures occurred in 52 patients (35%), with 40 fractures occurring post-transplantation. Ankle/foot fractures were most common (48%). Lower serum phosphorus levels and declining femoral neck (FN) T-score and were associated with fractures in both univariable and multivariable regression analyses after adjusting for age, gender, weight, estimated glomerular filtration rate and pre-transplant history of fracture (P=.011 and P=.042 respectively). The relationship between serum phosphorus and fracture remained significant independent of FN T-score, parathyroid hormone levels, parathyroidectomy status and prednisolone use.
Fracture was common post-renal transplantation. Lower serum phosphorus levels and declining FN T-scores were associated with fractures. The mechanism of this previously unreported observation requires further evaluation in prospective studies.
与普通人群相比，肾移植受者（RTR）的骨折发生率更高。风险因素包括年龄、糖尿病、透析时间、免疫抑制以及矿物质和骨代谢紊乱。肾移植后血清磷水平降低；然而，其与骨折风险的关系尚未得到评估。本研究的目的是评估一家三级转诊中心的RTR骨折风险因素。
对146例肾移植后接受双能X线骨密度仪（DXA）检查的患者（75例男性，71例女性）进行回顾性横断面分析。记录终末期肾病（ESKD）的病因、透析时间、甲状旁腺切除术史、免疫抑制方案、骨矿物质密度（BMD）、生化指标和骨折情况。统计分析包括单变量和多变量回归。
患者的平均年龄为54岁，平均移植后时间为6.7年。52例患者（35%）共发生79处骨折，其中40处骨折发生在移植后。踝/足部骨折最为常见（48%）。在调整年龄、性别、体重、估计肾小球滤过率和移植前骨折史后，单变量和多变量回归分析均显示，较低的血清磷水平和股骨颈（FN）T值下降与骨折相关（分别为P = 0.011和P = 0.042）。血清磷与骨折之间的关系在独立于FN T值、甲状旁腺激素水平、甲状旁腺切除术状态和泼尼松龙使用情况时仍然显著。
肾移植后骨折很常见。较低的血清磷水平和FN T值下降与骨折相关。这一先前未报道的观察结果的机制需要在前瞻性研究中进一步评估。
