Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China.
Department of Internal Medicine, Endocrine section, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.
Osteoporos Int. 2018 Sep;29(9):2129-2138. doi: 10.1007/s00198-018-4592-8. Epub 2018 Jun 15.
Early renal dysfunction is associated with a 38% increased fracture risk in individuals aged 65 years and older. In men but not women, early renal dysfunction is associated with decreased femoral neck bone mineral density (BMD) which can be partially explained by increased parathyroid hormone (PTH) concentrations.
It is uncertain whether early renal dysfunction is associated with osteoporosis and increased fracture risk. The aim of this study was to determine the relationship of decreased renal function with BMD and fracture risk and the role of PTH therein.
We analyzed data of participants aged 65 years and older from the Longitudinal Aging Study Amsterdam. A 6-year fracture follow-up was obtained in 1477 participants. BMD was measured by dual-energy x-ray absorptiometry (n = 535) and vertebral fractures by lateral spinal radiograph (n = 527) in a subsample at baseline. Glomerular filtration rate (eGFR) was estimated according to the modification of diet in renal disease equation and assessed by the five stages of chronic kidney disease (CKD).
In men and women, eGFR < 57 ml/min/1.73 m (lowest quartile) compared to eGFR > 74 ml/min/1.73 m (highest quartile) was associated with a 38% increase in fracture risk after adjustment for relevant confounders [hazard ratio (95%CI): 1.38 (1.17 to 1.61)]. Also, CKD stages 3a and 3b were associated to a 28 and 46% increase in fracture risk, respectively, as compared to CKD stages 1 and 2 together (eGFR > 60 ml/min/1.73 m) after adjustment for confounders. Renal function was not associated with prevalent vertebral fractures. In men, but not women, lowest quartile of eGFR was related to lower femoral neck BMD as compared to the highest quartile eGFR [unstandardized B (95%CI) - 0.052 g/cm (- 0.098 to - 0.006)], after adjustment for relevant confounders. Further adjustment for PTH attenuated this relationship by 27%.
In men and women, early decreased renal function (eGFR < 60 ml/min/1.73 m) was related to increased incident any fracture risk but not with increased prevalence of vertebral fractures. In men, but not women, early renal dysfunction was related to lower femoral neck BMD which could statistically be partially explained by increased PTH concentrations.
本研究旨在确定肾功能减退与 BMD 和骨折风险的关系，以及甲状旁腺激素（PTH）在其中的作用。
我们分析了阿姆斯特丹纵向老龄化研究中年龄在 65 岁及以上的参与者的数据。在 1477 名参与者中，有 6 年的骨折随访。在基线时，通过双能 X 射线吸收法（n=535）测量骨密度（BMD），通过侧位脊柱 X 线片（n=527）测量椎体骨折。根据肾脏病饮食改良公式估计肾小球滤过率（eGFR），并根据慢性肾脏病（CKD）的五个阶段进行评估。
在男性和女性中，与 eGFR >74ml/min/1.73m（最高四分位）相比，eGFR <57ml/min/1.73m（最低四分位）与调整相关混杂因素后骨折风险增加 38%相关[风险比（95%CI）：1.38（1.17 至 1.61）]。此外，与 CKD 阶段 1 和 2 一起（eGFR >60ml/min/1.73m）相比，CKD 阶段 3a 和 3b 分别与骨折风险增加 28%和 46%相关。肾功能与现患椎体骨折无关。在男性中，但在女性中，与最高四分位 eGFR 相比，最低四分位 eGFR 与股骨颈 BMD 降低相关[未标准化 B（95%CI）：-0.052g/cm（-0.098 至 -0.006）]，调整相关混杂因素后。进一步调整 PTH 使这种关系减弱了 27%。
在男性和女性中，早期肾功能减退（eGFR <60ml/min/1.73m）与新发任何骨折风险增加有关，但与椎体骨折发生率增加无关。在男性中，但在女性中，早期肾功能不全与股骨颈 BMD 降低有关，PTH 浓度升高可在统计学上部分解释这一关系。
