Brunerová Ludmila, Lažanská Renata, Kasalický Petr, Verešová Jana, Potočková Jana, Fialová Alena, Rychlík Ivan
II. Internal Department, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Šrobárova 50, 100 34, Prague 10, Czech Republic.
Bone Metabolism Unit, Affidea, Prague, Czech Republic.
Int Urol Nephrol. 2018 Sep;50(9):1721-1728. doi: 10.1007/s11255-018-1958-y. Epub 2018 Aug 16.
Bone involvement represents one of the complications of end-stage chronic kidney disease, with fractures being its major risk. The aim of our study was to assess the frequency and predictors of low-trauma fractures in a cohort of maintenance hemodialysis patients followed-up on for 2 years.
59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafiltration underwent initially laboratory (markers of calcium-phosphate metabolism and bone turnover markers) and densitometry examination with TBS assessment (Lunar Prodigy, TBS software 2.1.2). During 24-month follow-up, the frequency of low-trauma fractures was assessed and possible predictors of increased fracture risk were identified using product-moment correlation matrices.
Altogether 7 (11.9%) low-trauma fractures were observed. In the whole group, age (P = 0.047), T-score in proximal femur (P = 0.04), low vitamin D, low BMI (P = 0.03 for both), and higher FRAX for major osteoporotic fracture (P = 0.01) were connected with fractures, but in multi-variate analysis only BMI remained significantly negatively associated with fractures (P = 0.047). TBS and bone turnover markers failed to predict fractures. However, women with fractures had significantly lower serum phosphate (P = 0.03) and higher parathyroid hormone (P = 0.04). Parameters of hip structure analysis significantly correlated with FRAX, but not with fractures.
In a group of hemodialysis patients from one centre, T-score in proximal femur, low vitamin D, low BMI, and high FRAX for major osteoporotic fracture were associated with low-trauma fractures, however, in multi-variate analysis only low BMI remained a significant predictor of fracture risk.
骨受累是终末期慢性肾脏病的并发症之一，骨折是其主要风险。我们研究的目的是评估一组维持性血液透析患者随访2年期间低创伤骨折的发生率及预测因素。
59例接受血液透析滤过治疗的患者（年龄67.6±13.1岁，男性43例）最初接受了实验室检查（钙磷代谢标志物和骨转换标志物）以及采用TBS评估的骨密度检查（Lunar Prodigy，TBS软件2.1.2）。在24个月的随访期间，评估低创伤骨折的发生率，并使用积差相关矩阵确定骨折风险增加的可能预测因素。
共观察到7例（11.9%）低创伤骨折。在整个研究组中，年龄（P = 0.047）、股骨近端T值（P = 0.04）、维生素D水平低、体重指数低（两者P均 = 0.03）以及主要骨质疏松性骨折的FRAX值较高（P = 0.01）与骨折有关，但在多变量分析中，只有体重指数与骨折仍存在显著负相关（P = 0.047）。TBS和骨转换标志物未能预测骨折。然而，发生骨折的女性血清磷酸盐水平显著较低（P = 0.03），甲状旁腺激素水平较高（P = 0.04）。髋部结构分析参数与FRAX显著相关，但与骨折无关。
在来自一个中心的血液透析患者组中，股骨近端T值、维生素D水平低、体重指数低以及主要骨质疏松性骨折的FRAX值高与低创伤骨折有关，然而，在多变量分析中，只有低体重指数仍是骨折风险的显著预测因素。
