Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.
J Bone Miner Res. 2022 Nov;37(11):2094-2102. doi: 10.1002/jbmr.4681. Epub 2022 Sep 2.
Low bone mineral density (BMD) is suggested to be associated with increased mortality in the general health population, but the relationship in chronic kidney disease (CKD) patients is still unclear. We performed a meta-analysis to investigate the association of BMD in different sites with risk of all-cause mortality in CKD patients. We searched PubMed, EMBASE, and Web of Science to identify eligible cohort studies that evaluated the association between BMD at different sites and risk of all-cause mortality in CKD patients. Twelve cohort studies were identified, which included 2828 CKD patients and 1052 deaths. Compared with normal/high level of total body BMD, lower total body BMD was associated with 25% higher risk of all-cause mortality. The pooled relative risk (RR) was 1.25 (95% confidence interval [CI] 1.09, 1.42) with little heterogeneity across studies. Regarding BMD measured at different sites, the risk of all-cause mortality was highest for lower BMD at hip/femoral neck (pooled RR = 1.69; 95% CI 1.20, 2.40). The pooled RRs were 1.26 (95% CI 1.04, 1.53) and 1.17 (95% CI 1.00, 1.37) for lower BMD at arm and spine, respectively. Similarly, the risk of death for per SD decrease in BMD was also higher at hip/femoral neck (pooled RR = 1.43, 95% CI 1.15, 1.77) compared with arm (pooled RR = 1.03, 95% CI 1.00, 1.06) and spine (pooled RR = 1.17, 95% CI 0.98, 1.39). In conclusion, lower BMD values at hip, arm, spine, as well as the whole body are associated with increased risk of all-cause mortality in CKD patients. The excess risk is highest for patients with lower BMD at hip/femoral neck, suggesting BMD measured at hip region may be the best indicator of mortality risk in CKD patients. © 2022 American Society for Bone and Mineral Research (ASBMR).
骨矿物质密度（BMD）降低与一般健康人群的死亡率增加有关，但在慢性肾脏病（CKD）患者中的关系尚不清楚。我们进行了一项荟萃分析，以调查不同部位的 BMD 与 CKD 患者全因死亡率风险之间的关系。我们检索了 PubMed、EMBASE 和 Web of Science，以确定评估不同部位 BMD 与 CKD 患者全因死亡率风险之间关系的合格队列研究。确定了 12 项队列研究，其中包括 2828 名 CKD 患者和 1052 例死亡。与全身 BMD 正常/高相比，全身 BMD 降低与全因死亡率增加 25%相关。汇总相对风险（RR）为 1.25（95%置信区间 [CI] 1.09，1.42），研究间异质性较小。关于不同部位测量的 BMD，髋部/股骨颈 BMD 降低的全因死亡率风险最高（汇总 RR=1.69；95%CI 1.20，2.40）。手臂和脊柱 BMD 降低的汇总 RR 分别为 1.26（95%CI 1.04，1.53）和 1.17（95%CI 1.00，1.37）。同样，髋部/股骨颈 BMD 每降低 1 个标准差，死亡风险也高于手臂（汇总 RR=1.43，95%CI 1.15，1.77）（汇总 RR=1.03，95%CI 1.00，1.06）和脊柱（汇总 RR=1.17，95%CI 0.98，1.39）。总之，髋部、手臂、脊柱以及全身的 BMD 值降低与 CKD 患者全因死亡率风险增加相关。髋部/股骨颈 BMD 降低的患者风险最高，这表明髋部区域的 BMD 测量可能是 CKD 患者死亡风险的最佳指标。
