Abstract
BackgroundLow bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients.MethodsSixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD) assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass.ResultsUsing WHO criteria as a cutoff point, fifty-one subjects (81%) had a T-score lower than -1, of them 8 subjects (13%) had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP) level, and intact parathyroid hormone (iPTH) level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW) had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R2 × 0.25), whereas BW and the ALP level significantly predicted the lumbar spine BMD (R2 × 0.20).ConclusionThis study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health in the patients undergoing hemodialysis.
Highlights
Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis
Since the osteoporosis is one of main bone health problems in the chronic kidney disease (CKD) patients and the incidence of hemodialysis increased rapidly in Taiwan, this study aims to investigate the status of bone mineral density (BMD) among hemodialysis patients in Taiwan and to explore the associated factors related to loss of bone mass
We found that BMD decreased as age increased and BMD increased as body weight (BW) increased in lumbar spine (LS) and femoral neck (FN)
Summary
Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients. ESRD patients usually have an accelerated bone loss due to abnormal bone turnover that leads to a high prevalence of bone health problems, e.g., osteopenia and osteoporosis etc. Parathyroid hormone (PTH)related bone disease influences bone mineral density (BMD) in hemodialysis patients, in addition to other important risk factors such as advanced age, age at menarche, female gender, and history of previous fractures, etc. Protective factors for bone mass loss in this population include body weight (BW), hemoglobin, weekly heparin dose and a history of parathyroidectomy, etc. Protective factors for bone mass loss in this population include body weight (BW), hemoglobin, weekly heparin dose and a history of parathyroidectomy, etc. [7]
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