The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone

Jansz, T. T.; Goto, N. A.; van Ballegooijen, A. J.; Willems, H. C.; Verhaar, M. C.; van Jaarsveld, B. C.

Affiliations

¹Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

²Dianet Dialysis Centers, Utrecht, the Netherlands

³Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

⁴Department of Nephrology and Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

⁵Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

⁶Department of Geriatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

Abstract and keywords

Summary: The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk.

Introduction: Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture.

Methods: In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture.

Results: Mean age of the study population was 52 ± 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13–55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (≥ 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders.

Conclusions: The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using DXA and assessed vertebral fractures using lateral chest radiographs and not spine radiographs.

Keywords: End-stage renal disease; Parathyroid hormone; Vertebral bone mineral density; Vertebral fracture

Links

DOI: 10.1007/s00198-019-05187-0

PubMed: 31728605

WoS: 000519860900012

History

Received: 2019-05-02

Accepted: 2019-10-09

Online: 2019-11-14

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Cited By (1)

Year	Entry
2023	Sato H, Goto M, Nishimura G, Morimoto N, Tokushima H, Horii Y, Takahashi N. Upacicalcet, a positive allosteric modulator of the calcium-sensing receptor, prevents vascular calcification and bone disorder in a rat adenine-induced secondary hyperparathyroidism model. Bone. February 2023;167:116613.