Calcified Tissue International

, Volume 93, Issue 1, pp 39–47 | Cite as

High Prevalence of Vertebral Fractures Assessed by Quantitative Morphometry in Hemodialysis Patients, Strongly Associated with Vascular Calcifications

  • Maria Fusaro
  • Giovanni Tripepi
  • Marianna Noale
  • Nicola Vajente
  • Mario Plebani
  • Martina Zaninotto
  • Giuseppe Guglielmi
  • Diego Miotto
  • Luca Dalle Carbonare
  • Angela D’Angelo
  • Daniele Ciurlino
  • Riccarda Puggia
  • Davide Miozzo
  • Sandro Giannini
  • Maurizio Gallieni
Original Research


Few studies have provided information on the prevalence of vertebral fractures (VFs) and their risk factors in hemodialysis patients. A multicenter, cross-sectional, observational study was carried out to assess the prevalence of VFs and vascular calcifications (VCs) in 387 hemodialysis patients (mean age 64.2 ± 14.1 years, 63 % males) and in a control group of 51 osteoporotic subjects. Biochemical tests included 25(OH) vitamin D, bone Gla protein (total and undercarboxylated), and total matrix Gla protein. Vertebral quantitative morphometry was carried out centrally for the detection of VF, defined as reduction by ≥20 % of one of the vertebral body dimensions. In the same radiograph, aortic and iliac VC scores were calculated. Prevalence of VF was 55.3 % in hemodialysis patients and 51.0 % in the control group. Multivariate analysis disclosed that male gender (59.8 vs. 47.6 %, p = 0.02; OR = 1.78, 95 % CI 1.15–2.75) and age (mean ± SD 66.7 ± 13.1 vs. 61.0 ± 14.7 years, p < 0.001; OR = 1.03, 95 % CI 1.01–1.05) were significantly associated with VF. The prevalence of aortic VC was significantly higher in hemodialysis patients than in controls (80.6 vs. 68.4 %, p = 0.001). The factors with the strongest association with VC, apart from atrial fibrillation, were serum 25(OH)vitamin D levels below 29 ng/mL for aortic VC (OR = 1.85, 95 % CI 1.04–3.29) and VF both for aortic (OR = 1.77, 95 % CI 1.00–3.14) and iliac (OR = 1.96, 95 % CI 1.27–3.04) VC. In conclusion, the prevalence of VF, especially in males, and VC, in both genders, is high in hemodialysis patients. VF is associated with VC. Vitamin D deficiency is also associated with VC. Further longitudinal studies are warranted to investigate fractures in renal patients.


Vertebral fracture Vascular calcification Hemodialysis Prevalence Vitamin D 



The authors thank Jennifer Hartwig, MD, medical writer, for manuscript editing. The study was funded by the Consiglio Nazionale delle Ricerche (CNR), Aging Section, Institute of Neuroscience, Padua, Italy. The authors also state that they have full control of all primary data and that they agree to allow the journal to review their data if requested.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Maria Fusaro
    • 1
  • Giovanni Tripepi
    • 2
  • Marianna Noale
    • 1
  • Nicola Vajente
    • 3
  • Mario Plebani
    • 3
  • Martina Zaninotto
    • 3
  • Giuseppe Guglielmi
    • 4
    • 5
  • Diego Miotto
    • 6
  • Luca Dalle Carbonare
    • 7
  • Angela D’Angelo
    • 8
  • Daniele Ciurlino
    • 9
  • Riccarda Puggia
    • 10
  • Davide Miozzo
    • 8
  • Sandro Giannini
    • 11
  • Maurizio Gallieni
    • 12
  1. 1.Aging SectionConsiglio Nazionale delle Ricerche (CNR)—Institute of NeurosciencePaduaItaly
  2. 2.Clinical Epidemiology and Physiopathology of Renal Diseases and HypertensionCNR-Istituto di BiometeorologiaReggio CalabriaItaly
  3. 3.Dipartimento di Medicina di LaboratorioUniversity Hospital of PaduaPaduaItaly
  4. 4.Department of RadiologyUniversity of FoggiaFoggiaItaly
  5. 5.Department of RadiologyScientific Institute Hospital “Casa Sollievo della Sofferenza”San Giovanni RotondoItaly
  6. 6.Dipartimento di Medicina, Sezione di RadiologiaUniversity of PaduaPaduaItaly
  7. 7.Department of Medicine, Medicina Interna DUniversity of VeronaVeronaItaly
  8. 8.Nephrology UnitUniversity of PaduaPaduaItaly
  9. 9.Renal UnitIRCCS MultimedicaMilanItaly
  10. 10.Nephrology and Dialysis UnitOspedale S. Maria di Ca’ FoncelloTrevisoItaly
  11. 11.Department of Clinical and Experimental Medicine, Medical Clinic 4University of PaduaPaduaItaly
  12. 12.Nephrology and Dialysis UnitOspedale San Carlo BorromeoMilanItaly

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