Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden.
Department of Orthopedics, Skåne University Hospital, 214 28, Malmö, Sweden.
Osteoporos Int. 2017 Dec;28(12):3463-3473. doi: 10.1007/s00198-017-4221-y. Epub 2017 Oct 16.
Kidney function decreases with age; however, the long-term influence on bone density (BMD) in older women already at risk of osteoporosis is unknown. We followed kidney function and bone loss for 10 years. Declining kidney function was adversely associated with bone loss and mineral homeostasis in old women, though it attenuated with advanced aging.
Existing studies do not fully address the relationship between kidney function and bone metabolism with advanced aging in Caucasian women. This study describes the association between kidney function, BMD, bone loss and bone metabolism in older women and provides a review of the available literature for context.
We studied participants from the OPRA cohort with follow-up after 5 and 10 years. Using plasma cystatin C (cysC), estimated glomerular function rate (eGFR) was evaluated at age 75 (n = 981), 80 (n = 685) and 85 (n = 365). Women were stratified into "normal" function (CKD stages 1-2), "intermediate" (stage 3a) and "poor" (stages 3b-5), and outcome measures-BMD, bone loss and markers of mineral homeostasis-were compared.
Femoral neck (FN) BMD positively associated with kidney function at 75 years old ([Formula: see text] = 0.001, p = 0.028) and 80 years old ([Formula: see text] = 0.001, p = 0.001), although with small effect size. Prevalence of osteoporosis (FN T-score ≤ - 2.5) did not differ with kidney function. Measured at age 75, women with poor kidney function had higher annual percentage bone loss over 5 years compared to those with normal function (2.3%, 95% CI 1.8-2.8 versus 1.3%, 95% CI 1.1-1.5, p = 0.007), although not when measured from age 80 or 85. Additionally, markers of mineral homeostasis (PTH, phosphate, vitamin D, calcium), CRP and osteocalcin differed by kidney function.
In old women, kidney function is associated with BMD, bone loss and altered mineral homeostasis; probably, a relationship attenuated in the very elderly.
肾功能随年龄增长而下降；然而，对于已经处于骨质疏松症风险中的老年女性，其长期的骨密度（BMD）影响尚不清楚。我们对 10 年的肾功能和骨丢失进行了随访。在老年女性中，肾功能下降与骨丢失和矿物质内稳态呈负相关，但随着衰老的进展而减弱。
现有的研究并没有充分阐明在白种女性中肾功能与骨代谢随增龄的关系。本研究描述了肾功能、BMD、骨丢失和骨代谢在老年女性中的关系，并对现有文献进行了综述。
我们研究了 OPRA 队列中的参与者，随访时间为 5 年和 10 年。使用血浆胱抑素 C（cysC），在 75 岁（n=981）、80 岁（n=685）和 85 岁（n=365）时评估估算肾小球滤过率（eGFR）。女性分为“正常”功能（CKD 1-2 期）、“中间”（3a 期）和“差”（3b-5 期），比较了骨密度、骨丢失和矿物质内稳态标志物等结局指标。
股骨颈（FN）BMD 与 75 岁时的肾功能呈正相关（[Formula: see text]=0.001，p=0.028）和 80 岁时的肾功能呈正相关（[Formula: see text]=0.001，p=0.001），尽管效应大小较小。骨质疏松症的患病率（FN T 评分≤-2.5）与肾功能无关。在 75 岁时测量，肾功能差的女性在 5 年内的年骨丢失率高于肾功能正常的女性（2.3%，95%CI 1.8-2.8 比 1.3%，95%CI 1.1-1.5，p=0.007），尽管从 80 岁或 85 岁开始测量时并非如此。此外，矿物质内稳态标志物（PTH、磷酸盐、维生素 D、钙）、C 反应蛋白和骨钙素的水平因肾功能而异。
在老年女性中，肾功能与 BMD、骨丢失和矿物质内稳态改变有关；可能在非常高龄的人群中，这种关系会减弱。
