Jirasirirak Sasipim, Disthabanchong Sinee, Ongphiphadhanakul Boonsong, Arj-Ong Vallibhakara Sakda, Nimitphong Hataikarn
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Heliyon. 2022 Mar 23;8(3):e09158. doi: 10.1016/j.heliyon.2022.e09158. eCollection 2022 Mar.
This study aimed to investigate the prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease undergoing hemodialysis.
This cross-sectional study included 80 patients with end-stage renal disease undergoing hemodialysis. Medical history, Fracture Risk Assessment Tool and anteroposterior and lateral radiographs of the thoracolumbar and lumbosacral spine were obtained. Vertebral fractures were identified using the Genant semiquantitative assessment.
Radiography demonstrated asymptomatic vertebral fracture in 22 patients (27.5%). FRAX® results for major osteoporotic fracture (area under the curve, 0.64) and hip fracture (area under the curve, 0.62) were able to discriminate patients with prevalent asymptomatic vertebral fracture. A multivariate analysis demonstrated that a 1-year average corrected calcium (odds ratio, 0.38), steroid use (odds ratio, 8.99), and a serum albumin concentration <25 g/dL (odds ratio, 28.82) significantly predicted prevalent asymptomatic vertebral fracture (clinical model; area under the curve, 0.82). Combining the 1-year average corrected calcium and serum albumin concentration <25 g/dL with FRAX® results for major osteoporotic fracture (area under the curve, 0.78) and FRAX® results for hip (area under the curve, 0.75) produced a significantly greater area under the curve value to predict fracture when compared with FRAX® result for major osteoporotic fracture and FRAX® result for hip (P = 0.022).
Asymptomatic vertebral fracture is prevalent. FRAX® results for major osteoporotic fracture and hip provided lower ability in predicting asymptomatic vertebral facture when compared to the clinical model. Combining a 1-year average corrected calcium and serum albumin concentration <25 g/dL with FRAX® result for major osteoporotic fracture or hip improved the model's performance and provided comparable area under the curve to the clinical model.
本研究旨在调查接受血液透析的终末期肾病患者无症状椎体骨折的患病率及预测因素。
这项横断面研究纳入了80例接受血液透析的终末期肾病患者。收集了病史、骨折风险评估工具以及胸腰椎和腰骶椎的前后位及侧位X线片。使用Genant半定量评估法识别椎体骨折。
X线检查显示22例患者（27.5%）存在无症状椎体骨折。主要骨质疏松性骨折的FRAX®结果（曲线下面积，0.64）和髋部骨折的FRAX®结果（曲线下面积，0.62）能够区分存在无症状椎体骨折的患者。多因素分析表明，1年平均校正钙水平（比值比，0.38）、使用类固醇（比值比，8.99）以及血清白蛋白浓度<25 g/dL（比值比，28.82）是无症状椎体骨折的显著预测因素（临床模型；曲线下面积，0.82）。与主要骨质疏松性骨折的FRAX®结果和髋部的FRAX®结果相比，将1年平均校正钙水平和血清白蛋白浓度<25 g/dL与主要骨质疏松性骨折的FRAX®结果（曲线下面积，0.78）和髋部的FRAX®结果（曲线下面积，0.75）相结合，预测骨折的曲线下面积值显著更大（P = 0.022）。
无症状椎体骨折很常见。与临床模型相比，主要骨质疏松性骨折和髋部的FRAX®结果预测无症状椎体骨折的能力较低。将1年平均校正钙水平和血清白蛋白浓度<25 g/dL与主要骨质疏松性骨折或髋部的FRAX®结果相结合，可改善模型性能，并提供与临床模型相当的曲线下面积。
