Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Dialysis Unit, Regional Specialist Hospital, Radom, Poland.
Osteoporos Int. 2018 May;29(5):1105-1115. doi: 10.1007/s00198-018-4406-z. Epub 2018 Feb 6.
We assessed the FRAX® method in 718 hemodialyzed patients in estimating increased risk of bone major and hip fractures. Over two prospective years, statistical analysis showed that FRAX® enables a better assessment of bone major fracture risk in these patients than any of its components and other risk factors considered in the analysis.
Despite the generally increased risk of bone fractures among patients with end-stage renal disease, no prediction models for identifying individuals at particular risk have been developed to date. The goal of this prospective, multicenter observational study was to assess the usefulness of the FRAX® method in comparison to all its elements considered separately, selected factors associated with renal disease and the history of falls, in estimating increased risk of low-energy major bone and hip fractures in patients undergoing chronic hemodialysis.
The study included a total of 1068 hemodialysis patients, who were followed for 2 years, and finally, 718 of them were analyzed. The risk analysis included the Polish version of the FRAX® calculator (without bone mineral density), dialysis vintage, mineral metabolism disorders (serum calcium, phosphate, and parathyroid hormone), and the number of falls during the last year before the study.
Over 2 years, low-energy 30 major bone fractures were diagnosed and 13 of hip fractures among them. Area under the curve for FRAX® was 0.76 (95% CI 0.69-0.84) for major fractures and 0.70 (95% CI 0.563-0.832) for hip fractures. The AUC for major bone fractures was significantly higher than for all elements of the FRAX® calculator. In logistic regression analysis FRAX® was the strongest independent risk factor of assessment of the major bone fracture risk.
FRAX® enables a better assessment of major bone fracture risk in ESRD patients undergoing hemodialysis than any of its components and other risk factors considered in the analysis.
我们评估了 FRAX®方法在 718 例血液透析患者中预测骨大骨折和髋部骨折风险增加的情况。经过 2 年的前瞻性研究，统计学分析表明，FRAX®能够比其任何组成部分和分析中考虑的其他危险因素更好地评估这些患者的骨大骨折风险。
尽管终末期肾病患者的骨折风险普遍增加，但迄今为止尚未开发出用于确定特定风险个体的预测模型。本前瞻性、多中心观察性研究的目的是评估 FRAX®方法与所有单独考虑的组成部分、与肾脏疾病相关的选定因素以及跌倒史相比，在估计接受慢性血液透析的患者中低能量大骨和髋部骨折风险增加方面的有用性。
这项研究共纳入了 1068 例血液透析患者，随访 2 年，最终分析了其中的 718 例患者。风险分析包括波兰版 FRAX®计算器（不包括骨密度）、透析时间、矿物质代谢紊乱（血清钙、磷和甲状旁腺激素）以及研究前 1 年的跌倒次数。
2 年内诊断出 30 例低能量大骨骨折，其中 13 例为髋部骨折。FRAX®对大骨折的曲线下面积为 0.76（95%CI 0.69-0.84），对髋部骨折的曲线下面积为 0.70（95%CI 0.563-0.832）。FRAX®对大骨折的 AUC 显著高于 FRAX®计算器的所有组成部分。在逻辑回归分析中，FRAX®是评估大骨折风险的最强独立危险因素。
FRAX®能够比其任何组成部分和分析中考虑的其他危险因素更好地评估接受血液透析的 ESRD 患者的大骨骨折风险。
