Park Hwajin, Han Suyeon, Hwang Yunkyeong, Choi Wonjung, Hong Yu Ah, Chang Yoon-Kyung
Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon 34943, Republic of Korea.
The College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
J Clin Med. 2024 Dec 17;13(24):7696. doi: 10.3390/jcm13247696.
: Osteoporosis is prevalent in patients with chronic kidney disease (CKD), with risk increasing as CKD progresses, subsequently elevating fracture risk. While previous studies have shown a link between low skeletal muscle mass and osteoporosis in the general population, there is limited research exploring this relationship in patients with advanced CKD (stages 3-5D). This study aimed to evaluate whether skeletal muscle area (SMA), as measured by abdominal CT, is correlated with bone mineral density (BMD) in advanced CKD patients beginning hemodialysis. : This single-center, retrospective cohort study included patients who started maintenance hemodialysis at Daejeon St. Mary's Hospital from January 2018 to September 2021. Patients who underwent abdominal CT and BMD assessments within three months of dialysis initiation were enrolled, resulting in a sample of 87 individuals. Baseline characteristics were analyzed, with patients stratified by sex and SMA quartiles. Pearson's correlation and multivariate regression analyses were conducted to the relationship between SMA and BMD T-scores. : The study cohort had an average age of 65.4 years, with 52.9% of participants being male. Male patients exhibited significantly higher SMA and BMD T-scores in both the lumbar spine and femur compared to female patients. SMA showed the strongest positive correlation with BMD at both sites (lumbar spine, r = 0.424; femur, r = 0.514; < 0.001). Multivariate analysis identified SMA as an independent positive predictor of BMD, while alkaline phosphatase (ALP) was independently associated with lower femur BMD. In the SMA-based subgroup analysis, patients with lower SMA had significantly lower BMD T-scores and a higher risk of osteoporosis. Logistic regression indicated that patients in the lowest SMA quartile had substantially increased odds of osteoporosis compared to those in the highest quartile, with an adjusted odds ratio of 30.59 ( = 0.008). : Lower skeletal muscle mass is significantly associated with lower bone density and a higher risk of osteoporosis in advanced CKD patients initiating hemodialysis. SMA, as measured by abdominal CT, may serve as a useful marker for identifying patients at elevated osteoporosis risk in this population.
骨质疏松症在慢性肾脏病（CKD）患者中很常见，其风险随着CKD的进展而增加，进而提高骨折风险。虽然先前的研究表明一般人群中低骨骼肌质量与骨质疏松症之间存在联系，但在晚期CKD（3 - 5D期）患者中探索这种关系的研究有限。本研究旨在评估腹部CT测量的骨骼肌面积（SMA）与开始血液透析的晚期CKD患者的骨密度（BMD）是否相关。 ：这项单中心回顾性队列研究纳入了2018年1月至2021年9月在大田圣母医院开始维持性血液透析的患者。纳入在透析开始后三个月内接受腹部CT和BMD评估的患者，最终样本为87人。分析基线特征，患者按性别和SMA四分位数分层。对SMA与BMD T值之间的关系进行Pearson相关性分析和多变量回归分析。 ：研究队列的平均年龄为65.4岁，52.9%的参与者为男性。男性患者在腰椎和股骨的SMA和BMD T值均显著高于女性患者。SMA在两个部位与BMD均呈现最强的正相关（腰椎，r = 0.424；股骨，r = 0.514；P < 0.001）。多变量分析确定SMA是BMD的独立阳性预测因子，而碱性磷酸酶（ALP）与较低的股骨BMD独立相关。在基于SMA的亚组分析中，SMA较低的患者BMD T值显著较低且骨质疏松风险较高。逻辑回归表明，SMA最低四分位数的患者与最高四分位数的患者相比，骨质疏松的几率大幅增加，调整后的优势比为30.59（P = 0.008）。 ：较低的骨骼肌质量与开始血液透析的晚期CKD患者较低的骨密度和较高的骨质疏松风险显著相关。通过腹部CT测量的SMA可作为识别该人群中骨质疏松风险升高患者的有用标志物。
