Hori Mayuko, Takahashi Hiroshi, Kondo Chika, Matsuoka Yutaka, Tsujita Makoto, Nishihira Morikuni, Uchida Kazuharu, Takeda Asami, Morozumi Kunio, Maruyama Shoichi
Department of Nephrology, Masuko Memorial Hospital, Nagoya, Japan.
Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.
Am J Nephrol. 2023;54(11-12):489-497. doi: 10.1159/000534019. Epub 2023 Sep 12.
Sarcopenia and osteoporosis are highly prevalent among kidney transplant recipients (KTRs). Although osteoporosis is known to increase fracture risk in KTRs, it is unclear whether sarcopenia or osteosarcopenia is associated with this increased risk. Thus, we aimed to investigate the association of the coexistence of low muscle mass (LMM) and osteoporosis with the risk of fracture in long-term KTRs.
Exactly 342 stable KTRs underwent dual-energy X-ray absorptiometry and skeletal muscle mass index (SMI) measurement using bioelectrical impedance analysis.
LMM and osteoporosis were observed in 109 (31.9%) and 93 patients (27.2%), respectively. During a follow-up period of 5.1 years, 48 (14.0%) fractures occurred. KTRs with LMM had a higher fracture risk, but this was not significant (adjusted hazard ratio [aHR] 1.82, 95% confidence interval [CI] 0.94-3.50, p = 0.073). Similar results were obtained in KTRs with osteoporosis (aHR 1.84, 95% CI 0.96-3.47, p = 0.063). We divided the KTRs into four groups according to the presence of LMM and/or osteoporosis. The cumulative incidence rates of fractures were 13.0%, 11.1%, 10.5%, and 31.3% in the KTRs without both LMM and osteoporosis, those with LMM alone, those with osteoporosis alone, and those with both, respectively. The KTRs with both LMM and osteoporosis had a 2.92fold higher risk of fractures (95% CI 1.29-6.49; p = 0.010) than those without both LMM and osteoporosis.
Long-term KTRs with the coexistence of LMM and osteoporosis had an independently higher risk of fragility fractures than those without both LMM and osteoporosis. The combination of SMI and osteoporosis definitions can be used to identify KTRs with a high fracture risk.
肌肉减少症和骨质疏松症在肾移植受者（KTRs）中非常普遍。虽然已知骨质疏松症会增加KTRs的骨折风险，但尚不清楚肌肉减少症或骨肌减少症是否与这种风险增加有关。因此，我们旨在研究长期KTRs中低肌肉量（LMM）与骨质疏松症并存与骨折风险之间的关联。
342例稳定的KTRs接受了双能X线吸收法检查，并使用生物电阻抗分析测量骨骼肌质量指数（SMI）。
分别在109例（31.9%）和93例患者（27.2%）中观察到LMM和骨质疏松症。在5.1年的随访期内，发生了48例（14.0%）骨折。有LMM的KTRs骨折风险较高，但不显著（调整后风险比[aHR]为1.82，95%置信区间[CI]为0.94 - 3.50，p = 0.073）。骨质疏松症的KTRs也得到了类似结果（aHR为1.84，95%CI为0.96 - 3.47，p = 0.063）。我们根据LMM和/或骨质疏松症的存在情况将KTRs分为四组。在既无LMM也无骨质疏松症的KTRs、仅患有LMM的KTRs、仅患有骨质疏松症的KTRs以及两者皆有的KTRs中，骨折的累积发生率分别为13.0%、11.1%、10.5%和31.3%。同时患有LMM和骨质疏松症的KTRs发生骨折的风险比既无LMM也无骨质疏松症的KTRs高2.92倍（95%CI为1.29 - 6.49；p = 0.010）。
长期并存LMM和骨质疏松症的KTRs发生脆性骨折的独立风险高于既无LMM也无骨质疏松症的KTRs。SMI和骨质疏松症定义的组合可用于识别骨折风险高的KTRs。
