Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
Department of Medicine, Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland.
Calcif Tissue Int. 2024 Nov;115(5):516-524. doi: 10.1007/s00223-024-01275-4. Epub 2024 Aug 20.
Cardiovascular disease is associated with increased fracture risk in the general population. Few data exist on the association between cardiovascular health and incident fracture risk in patients with advanced CKD, a high-risk population for fractures. We aimed to assess the link between fracture risk and cardiovascular health in a prospective cohort of 210 patients with CKD stage G4-5. Incident fractures were recorded during a prospective follow-up of 5 years. Laboratory parameters, abdominal aortic calcification score, echocardiography, ultrasound assessment of brachial artery flow-mediated dilatation and carotid intima-media thickness, and maximal stress ergometry were obtained at baseline. A total of 51 fractures were observed in 40 (19%) patients during follow-up. In separate multivariable Cox proportional hazards models adjusted for age, gender, and baseline eGFR, TnT (HR 1.007, CI 95% 1.003-1.010, p < 0.001) and ProBNP (HR 1.000, CI 95% 1.000-1.000, p = 0.017) were associated with incident fractures and the association persisted after adjusting for coronary artery disease (CAD). The patients unable to perform the ergometry test had a higher risk of incident fractures compared to others (36.1% vs 15.5%, p = 0.009). A cardiovascular composite risk score summarizing TnT, ProBNP, and ergometry data was independently associated with incident fractures in a multivariable Cox model (HR 1.373, CI 95% 1.180-1.599, p < 0.001). Patients with the lowest score were observed with no fractures, while patients with the highest score were observed with a fracture risk of 40.5% during follow-up. Risk of incident fractures is associated with biomarkers of cardiovascular health and a composite cardiovascular risk score in patients with advanced CKD.
心血管疾病与普通人群的骨折风险增加有关。在患有晚期 CKD（骨折高发人群）的患者中，关于心血管健康与骨折风险事件之间的关联，仅有少量数据。我们旨在评估 210 名 CKD 4-5 期患者前瞻性队列中骨折风险与心血管健康之间的联系。在 5 年的前瞻性随访期间记录骨折事件。在基线时获得实验室参数、腹主动脉钙化评分、超声心动图、肱动脉血流介导的扩张和颈动脉内膜中层厚度以及最大应激测功检查。在随访期间，40 名（19%）患者中观察到 51 例骨折。在分别调整年龄、性别和基线 eGFR 的多变量 Cox 比例风险模型中，TnT（HR 1.007，95%CI 1.003-1.010，p<0.001）和 ProBNP（HR 1.000，95%CI 1.000-1.000，p=0.017）与骨折事件相关，并且在调整冠状动脉疾病（CAD）后仍存在相关性。无法进行测功试验的患者与其他人相比，发生骨折的风险更高（36.1%比 15.5%，p=0.009）。多变量 Cox 模型中，综合 TnT、ProBNP 和测功数据的心血管复合风险评分与骨折事件独立相关（HR 1.373，95%CI 1.180-1.599，p<0.001）。得分最低的患者未发生骨折，而得分最高的患者在随访期间骨折风险为 40.5%。在患有晚期 CKD 的患者中，骨折风险与心血管健康的生物标志物和心血管复合风险评分相关。
