Abstract
We aim to determine the relationship between bone mineral density (BMD), measured by T- and Z–score, and mortality risk in hemodialysis (HD) patients. We also investigate which are the most suitable skeletal sites for predicting mortality rate. We analyzed the survival of 102 patients who had been treated with chronic HD according to BMD. Patients with a T-score ≤2.5 at the middle, ultradistal and proximal part of the forearm had a higher mortality risk than those with a T-score of −2.5 or higher. Furthermore, no statistically significant association was found between loss of bone mass at other measuring points—lumbar spine (anteroposterior orientation from L1–L4) and hip (neck, trochanter, intertrochanter, total and Ward’s triangle)—and mortality risk. We were also interested in exploring the relationship between Z-score at different skeletal regions and mortality risk. We found that patients with a Z-score of −1 or lower at all three parts of the forearm had a greater mortality risk. It is also worth noting that the Z-score at all three parts of the forearm was a more apparent predictor of mortality, compared to the T-score at the same skeletal regions. This empirical analysis showed that BMD assessments should be obtained at the forearm, due to the good predictability of this skeletal site regarding mortality of HD patients. Moreover, data concerning bone density should be reported as Z-scores.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Urena P, Poenaru-Bernard O, Ostertag A, Baudoin C, Solal-Cohen M, Cantor T et al (2003) Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 18:2325–2331
Chauhan V, Kelepouris E, Chauhan N, Vaid M (2012) Current concepts and management strategies in chronic kidney disease-mineral and bone disorder. South Med J 105:479–485
Mott S (2009) Review article: bone density in patients with chronic kidney disease stages 4-5. Nephrology 14:395–403
Taal MW, Roe S, Masud T, Green D, Porter C, Cassidy MJD (2003) Total hip bone mass predicts survival in chronic hemodialysis patients. Kidney Int 63:1116–1120
Ambrus C, Marton A, Nemeth ZK, Mucsi I (2010) Bone mineral density in patients on maintenance dialysis. Int Urol Nephrol 42:723–739
Ghosh AK (2004) Bone mineral density in the distal radius and increased risk of fractures in haemodialysis. Nephron Dial Transplant 19:1012–1013
Orlic L, Crncevic Z, Pavlovic D, Zaputovic L (2010) Bone mineral densitometry in patients on hemodialysis: difference between genders and what to measure. Ren Fail 32:300–308
World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis, Geneva. http://whqlibdoc.who.int/trs/WHO_TRS_843.pdf. Accessed 09 May 2016
Cosman F, De Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381
International Society for Clinical Densitometry. 2013 Official Positions—Adult. http://www.iscd.org/official-positions/2013-iscd-official-positions-adult/. Accessed May 2016
Dolgos S, Hartmann A, Bonsnes E et al (2008) Determinants of bone mass in end-stage renal failure patients at the time of kidney transplantation. Clin Transplant 22:462–468
Negri AL, Barone R, Lombas C et al (2006) Evaluation of cortical bone by peripheral quantitative computed tomography in continuous ambulatory peritoneal dialysis patients. Hemodial Int 10:351–355
Matsubara K, Suliman ME, Qureshi AR et al (2008) Bone mineral density in end-stage renal disease patients: association with waisting, cariovascular disease and mortality. Blood Purif 26:284–290
Park SH, Jia T, Qureshi AR, Bárány P, Heimbürger O, Larsson TE et al (2013) Determinants and survival implications of low bone mineral density in end-stage renal disease patients. J Nephrol 26:485–494
KDIGO Clinical Practice Guideline for the Diagnosis (2009) Evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD–MBD). Kidney Int 76:1–140
Obatake N, Ishimura E, Tsuchida T, Hirowatari K, Naka H, Imanishi Y et al (2007) Annual change in bone mineral density in predialysis patients with chronic renal failure: significance of a decrease in serum 1,25-dihydroxy vitamin D. J Bone Miner Metab 25:74–79
Disthabanchong S, Jongjirasiri S, Adirekkiat S et al (2014) Low hip bone mineral density predicts mortality in maintained hemodialysis patients: a five year follow-up study. Blood Purif 37:33–38
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Patients were informed of the purpose and method of the research, and the study was conducted in accordance with the Declaration of Helsinki. The study was approved by local ethical commission. Informed consent was obtained from all individual participants included in the study.
Conflict of interest
All authors have no any conflict of interest.
About this article
Cite this article
Orlic, L., Mikolasevic, I., Crncevic-Orlic, Z. et al. Forearm bone mass predicts mortality in chronic hemodialysis patients. J Bone Miner Metab 35, 396–404 (2017). https://doi.org/10.1007/s00774-016-0766-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00774-016-0766-7