Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
Department of Endocrinology, Beijing Liangxiang Hospital, Beijing, 102401, China.
Arch Osteoporos. 2023 Sep 11;18(1):116. doi: 10.1007/s11657-023-01324-9.
Early chronic kidney disease (CKD) and non-CKD individuals had similar morphometric vertebral fracture (mVF) incidence and longitudinal bone mineral density (BMD) change. CKD did not modify the association between BMD and incident mVF status. Patients with a higher baseline BMD had a higher longitudinal BMD loss in early CKD.
The aim of this 5-year longitudinal cohort study was to compare the risk of incident morphometric vertebral fracture (mVF) and longitudinal bone mineral density (BMD) change between individuals with early chronic kidney disease (CKD) and those without CKD.
A total of 869 Chinese postmenopausal women were enrolled in the study. Serum creatinine levels were assessed using standard methods, and estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Incident mVF was confirmed through lateral radiographs of the thoracolumbar spine. BMDs at the lumbar spine (LS) and femoral neck (FN) were measured using dual-energy X-ray absorptiometry. CKD was defined based on eGFR values: 60-89 mL/min/1.73m for stage 2 (n = 511) and 30-59 mL/min/1.73m for stage 3 (n = 92). The non-CKD group included individuals with an eGFR greater than or equal to 90 mL/min/1.73m.
The incidence of mVF was not statistically different between individuals with early CKD and those without CKD (4.1% in non-CKD, 6.3% in CKD stage 2, and 7.6% in CKD stage 3; p = 0.348). Neither eGFR nor CKD status was significantly associated with incident mVF in the multivariate logistic regression analysis. Baseline BMD T-scores were negatively associated with incident mVF (LS T-score, OR = 0.603, 95% CI = 0.468-0.777; FN T-score, OR = 0.511, 95% CI = 0.350-0.746). No evidence of interaction between BMD T-scores and CKD status were identified (p = 0.284-0.785) . The differences in longitudinal BMD changes between non-CKD and CKD groups were comparable (FN BMD: -6.31 ± 7.20% in non-CKD, -5.07 ± 8.20% in CKD stage 2, and -4.49 ± 8.40% in CKD stage 3, p = 0.556; LS BMD: -1.38 ± 8.18% in non-CKD, -0.32 ± 7.14% in CKD stage 2, and 1.5 ± 6.97% in CKD stage 3, p = 0.406). Individuals with a higher baseline FN BMD showed a greater longitudinal FN BMD loss (r = -0.185, p < 0.001) .
Our study revealed that early CKD was not associated with an increased risk of incident mVF or greater longitudinal BMD loss. Moreover, CKD did not modify the association between BMD and the risk of incident mVF, suggesting that the management and prevention of fractures in early CKD should be approached similarly to those without CKD. Measurement of BMD appears to be crucial for predicting incident mVF risk and longitudinal bone loss in early CKD.
本 5 年纵向队列研究旨在比较早期慢性肾脏病（CKD）患者和非 CKD 患者发生形态计量性椎体骨折（mVF）的风险和纵向骨密度（BMD）变化。
共纳入 869 名中国绝经后女性。采用标准方法检测血清肌酐水平，采用慢性肾脏病流行病学合作方程计算肾小球滤过率（eGFR）。通过胸腰椎侧位片确认新发生的 mVF。采用双能 X 线吸收法测量腰椎（LS）和股骨颈（FN）的 BMD。根据 eGFR 值定义 CKD：eGFR 为 60-89 mL/min/1.73m 为 2 期（n=511），30-59 mL/min/1.73m 为 3 期（n=92）。非 CKD 组包括 eGFR 大于或等于 90 mL/min/1.73m 的个体。
在多变量逻辑回归分析中，eGFR 或 CKD 状态与新发 mVF 均无显著相关性。基线 BMD T 评分与新发 mVF 呈负相关（LS T 评分，OR=0.603，95%CI=0.468-0.777；FN T 评分，OR=0.511，95%CI=0.350-0.746）。未发现 BMD T 评分与 CKD 状态之间存在交互作用（p=0.284-0.785）。非 CKD 组和 CKD 组之间的纵向 BMD 变化差异无统计学意义（FN BMD：非 CKD 组为-6.31±7.20%，CKD 2 期为-5.07±8.20%，CKD 3 期为-4.49±8.40%，p=0.556；LS BMD：非 CKD 组为-1.38±8.18%，CKD 2 期为-0.32±7.14%，CKD 3 期为 1.5±6.97%，p=0.406）。基线 FN BMD 较高的患者表现出更大的 FN BMD 纵向丢失（r=-0.185，p<0.001）。
本研究表明，早期 CKD 并不增加新发 mVF 或更大的纵向 BMD 丢失的风险。此外，CKD 并未改变 BMD 与新发 mVF 风险之间的关联，提示早期 CKD 骨折的管理和预防应与非 CKD 患者类似。BMD 测量对于预测早期 CKD 新发 mVF 风险和纵向骨丢失至关重要。
