Factors Affecting Bone Mineral Density in Hemodialysis Patients

Year 2018, Volume: 4 Issue: 3, 26 - 33, 27.12.2018

Ahmet Karataş , Ebru Çanakçı

https://doi.org/10.19127/mbsjohs.498264

Abstract

Objective: Disorders
of mineral metabolism and bone density are common complications in chronic
kidney disease and are an important cause of morbidity. Recently used
definition is chronic kidney disease-mineral and bone disorder (CKD-MBD). The
aim of our study was to evaluate the correlation between bone mineral density
and influencing factors in patients with end-stage renal failure undergoing
hemodialysis.

Material and Methods: In
our study, cases were evaluated by being divided into 3 groups depending on
bone mineral density (BMD). Our study included 124 cases and was designed as a
cross-sectional observational study. The demographic data of the cases were
recorded separately for each case. Routine biochemical analyses were studied.

Results: The median vit D value of the
patients with osteoporosis participated in the study was 14.44 mg/dl in the
osteopenic group and the median value of the patients without osteoporosis was
20.14 mg/dl. The lowest and highest vit D values of the patients with
osteoporosis were 3 mg/dl and 34.77 mg/dl, respectively. There was a
statistically significant difference between all 3 groups for the age variable
(p=0.002). There was a statistically significant difference between all 3
groups for the BMI variable (p=0.011). For 3 groups divided according to BMD
measurements, statistically significant results were found in the PTH,
Ferritin, Hgb, CRP, ALP, Albumin, e-GFR, hip and lumbar BMD values,
respectively (p<0.001, p=0.001, p=0.004, p=0.001, p=0.003,p=0.005, p=0.001,
p<0.001, p<0.001).

Conclusion: In conclusion, our study revealed that the most
important risk factor associated with osteoporosis in patients undergoing
hemodialysis was PTH elevation and low vitamin D levels. For this purpose, BMD
measurements and biochemical parameters of CKD patients undergoing hemodialysis
should be studied in appropriate periods by adhering to the guidelines. Vit D
replacement should not be neglected in order to avoid osteoporosis and to treat
the detected cases.

Keywords

Chronic Kidney Injury, Hemodialysis, Bone Mineral Density

References

• 1.Block GA, Cunningham J. Morbidity and mortality associated with abnormalities in bone and mineral metabolism in CKD. In: Olgaard K (ed). Clinical Guide to the Basics of Bone and Mineral Metabolism in CKD. chapter 4 National Kidney Foundation: New York, 2006, 77–92.
• 2.Freemont T, Malluche HH. Utilization of bone histomorphometry in renal osteodystrophy: demonstration of a new approach using data from a prospective study of lanthanum carbonate. Clin Nephrol 2005;63(2): 138–45.
• 3. Quarles LD, Berkoben M, Management of secondary hyperparathyroidism in dialysis patients Literature review current through: Nov 2018. | This topic last updated: Nov 06, 2018.
• 4. Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters. Kidney Int. 2017;92(1):26-36.
• 5. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis.Osteoporos Int.2014;25(10):2359-81.
• 6.Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994; 843: 1–1297. Posa F, Di Benedetto A, Colaianni G, Cavalcanti-Adam EA, Brunetti G, Porro C et al. Vitamin D Effects on Osteoblastic Differentiation of Mesenchymal Stem Cells from Dental Tissues. Stem Cells Int. 2016;2016:9150819. Epub 2016 Nov 13.
• 7. Posa F, Di Benedetto A, Colaianni G, Cavalcanti-Adam EA, Brunetti G, Porro C et al. Vitamin D Effects on Osteoblastic Differentiation of Mesenchymal Stem Cells from Dental Tissues. Stem Cells Int. 2016;2016:9150819. Epub 2016 Nov 13.
• 8.Tominaga Y, Matsuoka S, Sato T, Uno N, Goto N, Katayama A, et al. Clinical features and hyperplastic patterns of parathyroid glands in hemodialysis patients with advanced secondary hyperparathyroidism refractory to maxacalcitol treatment and required parathyroidectomy. Ther Apher Dial 2007; 11 (issue 4): 266-73
• 9. Defechereux T, Meurisse M. Renal hyperparathyroidism: Current therapeutic approach and future directions. Operative Tecniques in Otolaryngology 2009; 20(1) 71-8.
• 10.Aksu A, Zinnuroglu M, Karaoğlan B, Akın S, Kutsal YG, Atalay F, Dincer G. Osteoporosis, Education Status and Knowledge Level Research Results Osteoporosis’ s World 2005; 11(1) 36-40.
• 11. Festuccia F, Jafari MT, Moioli A, et al. Safety and efficacy of denosumab in osteoporotic hemodialysed patients, J Nephrol 2017 30(2) 271-9.
• 12. Sahin S Onat, Delialioğlu US, Özel S The Relationship Between Osteoporotic Risk Factors and Bone Mineral Density Turkish Journal of Osteoporosis, 2013;19: 74-80.
• 13. Ahmet Aslan, Emin Uysal, Özgür Karakoyun ,Bone Mineral Density Value in Kastamonu and Area of Turkish Society Women J Clin Anal Med 2013;4(3): 209-12.
• 14.O. Johnell J. A. Kanis An estimate of the worldwide prevalence and disability associated with osteoporotic fractures Osteoporos Int (2006) 17 (12):1726–1733
• 15.Posa F, Di Benedetto A, Colaianni G et al. Vitamin D effects onosteoblastic differentiation of mesenchymal stem cells from dentaltissues. Stem Cells Int. 2016; 2016: 9150819.
• 16.Elder GJ, Mackun K. 25-Hydroxyvitamin D deficiency and diabetes predict reduced BMD in patients with chronic kidney disease. J. Bone Miner. Res. 2006; 21(11): 1778 – 84.
• 17. Heike A. Bischoff-Ferrari, Thomas Dietrich, E. John Orav, Bess Dawson-Hughes Positive Association between 25-Hydroxy VitaminD Levels and Bone Mineral Density: A Population-Based Study of Younger and Older Adults May 1, 2004 The American Journal of Medicine Volume 116 (9), 634-39
• 18. Collins D, Jasani C, Fogelman I, Swaminathan R. Vitamin D andbone mineral density. Osteoporos Int. 1998;8 (2):110–114.
• 19. Fradinger EE, Zanchetta JR. Vitamin D and bone mineral density in ambulatory women living in Buenos Aires, Argentina. Osteoporos Int. 2001;12(1):24–27.
• 20. Mandıroğlu S, Unlü E, Aylı D The Evaluation of Renal Osteodystrophy in Patients on Hemodialysis by Biochemical and Radiological Methods Turkish Journal of Osteoporosis, 2013;19: 7-11
• 21. Hutchıson AJ, Whitehouse RW., Boulton HF., Adams JE., Mawer EB, Freemont TJ., and Gokal R Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease Kidney International, 1993 44 (5), 1071-77.
• 22. Yun Hwan Oh1 , Ji Hyun Moon1 , Belong Cho Association between Hemoglobin Level and Bone Mineral Density in Korean Adults J Bone Metab 2017;24(3):161-173
• 23. Huang GS, Chu TS, Lou MF,Hwang SL,Yang RS et al. Factors associated with low bone mass in the hemodialysis patients- a cross sectional correlation study. BMC Musculoskelet Disord 2009;10(60):1-10
• 24.Edwards BJ,Langman CB Bunta AD, Vicuna M. Favus M. Secondary contributors to bone loss in osteoporosis related hip fractures Osteoporosis International 2008;19(7):991–99
• 25. Huang JH, Cheng FC, Wu HC. Low Magnesium Exacerbates Osteoporosis in Chronic Kidney Disease Patients with Diabetes. Int J Endocrinol. 2015;2015:380247. doi: 10.1155/2015/380247