Abstract
Previous studies have reported inconsistent results regarding the associations between metabolic syndrome (MetS) and obesity-related indices and bone mineral density (BMD). However, no previous studies have reported these associations among hemodialysis (HD) patients. The aims of this study were to investigate associations between MetS and its components and BMD T-score in HD patients and also between obesity-related indices and BMD T-score in HD patients with and without MetS. MetS was defined according to the Adult Treatment Panel III for Asians, and BMD T-score was calculated using dual-energy X-ray absorptiometry. Eight obesity-related indices were evaluated, including lipid accumulation product (LAP), visceral adiposity index (VAI), body adiposity index, conicity index (CI), body roundness index (BRI), abdominal volume index (AVI), waist-to-height ratio (WHtR), waist–hip ratio, and body mass index (BMI). One hundred and sixty-four patients undergoing HD were enrolled, and the prevalence of MetS was 61.6%. MetS was significantly associated with high lumbar spine and total hip T-scores. Regarding the MetS components, abdominal obesity and low HDL-C were significantly associated with high lumbar spine, femoral neck, and total hip T-scores; hypertriglyceridemia was significantly associated with high lumbar spine and total hip T-scores; hyperglycemia was significantly associated with a high lumbar spine T-score, whereas high blood pressure was not associated with T-score at any site. In the patients with MetS, BMI, WHtR, AVI, and BRI were significantly associated with T-score at all sites, and high CI, VAI, and LAP were also related to a high lumbar T-score. However, these indices were not associated with T-score at any site in patients without MetS. This study demonstrated positive associations between MetS and its five components and BMD T-score among HD patients. MetS, abdominal obesity, hypertriglyceridemia, and low HDL-cholesterol were associated with low risk of osteoporosis among the HD patients. Furthermore, we found that some obesity-related indices were associated with BMD T-score among HD patients with MetS but not in those without MetS. Our study highlights the importance of BMI, WHtR, AVI, and BRI in predicting the risk of osteoporosis among HD patients with MetS. In clinical practice, they can be easily calculated through simple anthropometric measurements and routine laboratory examinations and be used to quickly and conveniently assess the risk of osteoporosis among HD patients.
Highlights
Osteoporosis is characterized by bone fragility caused by a loss of bone mass and deteriorating bone micro-architecture [1]
body mass index (BMI), waist-to-height ratio (WHtR), abdominal volume index (AVI), and body roundness index (BRI) were associated with high lumbar spine, femoral neck, and total hip T-scores
High confidence interval (CI), visceral adiposity index (VAI), and lipid accumulation product (LAP) were correlated with a high lumbar
Summary
Osteoporosis is characterized by bone fragility caused by a loss of bone mass and deteriorating bone micro-architecture [1]. The risk factors associated with osteoporosis can be classified as being modifiable (such as malnutrition, cigarettes smoking, and alcohol consumption), non-modifiable (such as age, gender, and ethnicity), and secondary (such as the prolonged use of medications, diabetes mellitus, and chronic kidney disease (CKD)) [3]. Patients receiving dialysis are at a higher risk of osteoporosis and fractures than the general population [4], and the prevalence of osteoporosis in this population has been reported to range from 23% to 42% [5,6]. Osteoporosis-related fractures have been associated with a higher mortality rate in patients undergoing dialysis [7]. The pathophysiology of osteoporosis in patients with end-stage renal disease is multifactorial and complex, involving the aforementioned risk factors and CKD-related bone abnormalities [8]
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