Journal of Bone and Mineral Metabolism

, Volume 27, Issue 2, pp 217–223 | Cite as

Determinants of prevalent vertebral fractures and progressive bone loss in long-term hemodialysis patients

  • Jan MaresEmail author
  • Kristina Ohlidalova
  • Sylvie Opatrna
  • Jiri Ferda
Original Article


Skeletal fractures are common in hemodialysis (HD) patients. However, consensus regarding technique and site of bone examination has not been reached in HD patients. Seventy-two patients (44% females) aged 65 (1.4) years, treated with HD for 43 (4.6) months were examined with quantitative computed tomography and 53 of them re-examined after 1 year. Bone mineral density (BMD) of lumbar spine was established separately for cortical and trabecular bone, prevalent vertebral fractures were determined. Data are given as mean (standard error). At least one vertebral fracture was discovered in 15 (21%) patients. In a logistic regression model, fractures were best predicted by cortical BMD: OR 0.96 (CI 0.94, 0.99), p < 0.005. With a multiple regression analysis, time on dialysis was found to be independently correlated to cortical BMD (R = 0.35, p < 0.005). On follow-up, a decrease of BMD was detected, which occurred only in the cortical region and was significantly greater in females than in males: −7% (1.7) versus 1.2% (1.9), p < 0.005. A time-dependent loss of vertebral cortical bone occurs in HD patients, especially in females. This decrement may impose an increased risk of fractures on long-term dialysis patients.


Hemodialysis Vertebral fractures Bone mineral density 



The study was supported by Research Project No. MSM0021620819 “Replacement of and Support to Some Vital Organs”, awarded by the Ministry of Education and Physical Training of the Czech Republic.


  1. 1.
    Sherrard DJ, Hercz G, Pei Y, Maloney NA, Greenwood C, Manuel A, Saiphoo C, Fenton SS, Segre GV (1993) The spectrum of bone disease in end-stage renal failure—an evolving disorder. Kidney Int 43:436–442PubMedCrossRefGoogle Scholar
  2. 2.
    Malluche HH, Monier-Faugere MC (1992) Risk of adynamic bone disease in dialyzed patients. Kidney Int Suppl 38:S62–S67PubMedGoogle Scholar
  3. 3.
    Gerakis A, Hadjidakis D, Kokkinakis E, Apostolou T, Raptis S, Billis A (2000) Correlation of bone mineral density with the histological findings of renal osteodystrophy in patients on hemodialysis. J Nephrol 13:437–443PubMedGoogle Scholar
  4. 4.
    Taal MW, Masud T, Green D, Cassidy MJ (1999) Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant 14:1922–1928PubMedCrossRefGoogle Scholar
  5. 5.
    Ureña P, Bernard-Poenaru O, Ostertag A, Baudoin C, Cohen-Solal M, Cantor T, de Vernejoul MC (2003) Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 18:2325–2331PubMedCrossRefGoogle Scholar
  6. 6.
    Stein MS, Packham DK, Ebeling PR, Wark JD, Becker GJ (1996) Prevalence and risk factors for osteopenia in dialysis patients. Am J Kidney Dis 28:515–522PubMedCrossRefGoogle Scholar
  7. 7.
    Barnas U, Schmidt A, Seidl G, Kaider A, Pietschmann P, Mayer G (2001) A comparison of quantitative computed tomography and dual X-ray absorptiometry for evaluation of bone mineral density in patients on chronic hemodialysis. Am J Kidney Dis 37:1247–1252PubMedCrossRefGoogle Scholar
  8. 8.
    Yamaguchi T, Kanno E, Tsubota J, Shiomi T, Nakai M, Hattori S (2005) Retrospective study on the usefulness of radius and lumbar bone density in the separation of hemodialysis patients with fractures from those without fractures. J Nephrol 18:458–463Google Scholar
  9. 9.
    Negri AL, Barone R, Quiroga MA, Bravo M, Marino A, Fradinger E, Bogado CE, Zanchetta J (2004) Bone mineral density: serum markers of bone turnover and their relationships in peritoneal dialysis. Perit Dial Int 24:163–168PubMedGoogle Scholar
  10. 10.
    Inaba M, Okuno S, Kumeda Y, Yamakawa T, Ishimura E, Nishizawa Y (2005) Increased incidence of vertebral fracture in older female hemodialyzed patients with type 2 diabetes mellitus. Calcif Tissue Int 76:256–260PubMedCrossRefGoogle Scholar
  11. 11.
    Fletcher S, Jones RG, Rayner HC, Harnden P, Hordon LD, Aaron JE, Oldroyd B, Brownjohn AM, Turney JH, Smith MA (1997) Assessment of renal osteodystrophy in dialysis patients: use of bone alkaline phosphatase, bone mineral density and parathyroid ultrasound in comparison with bone histology. Nephron 75:412–419PubMedCrossRefGoogle Scholar
  12. 12.
    Gordon CL, Lang TF, Augat P, Genant HK (1998) Image-based assessment of spinal trabecular bone structure from high-resolution CT images. Osteoporos Int 8:317–325PubMedCrossRefGoogle Scholar
  13. 13.
    Qi Q, Monier-Faugere MC, Geng Z, Malluche HH (1995) Predictive value of serum parathyroid hormone levels for bone turnover in patients on chronic maintenance dialysis. Am J Kidney Dis 26:622–631PubMedCrossRefGoogle Scholar
  14. 14.
    Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399PubMedCrossRefGoogle Scholar
  15. 15.
    Kaji H, Suzuki M, Yano S, Sugimoto T, Chihara K, Hattori S, Sekita K (2002) Risk factors for hip fracture in hemodialysis patients. Am J Nephrol 22:325–331PubMedCrossRefGoogle Scholar
  16. 16.
    Atsumi K, Kushida K, Yamazaki K, Shimizu S, Ohmura A, Inoue T (1999) Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis 33:287–293PubMedCrossRefGoogle Scholar
  17. 17.
    Rodriguez Garcia M, Naves Diaz M, Cannata Andia JB (2005) Bone metabolism, vascular calcifications and mortality: associations beyond mere coincidence. J Nephrol 18:458–463PubMedGoogle Scholar
  18. 18.
    O’Neill TW, Cockerill W, Matthis C, Raspe HH, Lunt M, Cooper C, Banzer D, Cannata JB, Naves M, Felsch B, Felsenberg D, Janott J, Johnell O, Kanis JA, Kragl G, Lopes Vaz A, Lyritis G, Masaryk P, Poor G, Reid DM, Reisinger W, Scheidt-Nave C, Stepan JJ, Todd CJ, Woolf AD, Reeve J, Silman AJ (2004) Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int 15:760–765PubMedCrossRefGoogle Scholar
  19. 19.
    Hasserius R, Karlsson MK, Jónsson B, Redlund-Johnell I, Johnell O (2005) Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly: a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 76:235–242PubMedCrossRefGoogle Scholar
  20. 20.
    K/DOQI (2002) Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney disease outcome quality initiative. Am J Kidney Dis 39:S1Google Scholar
  21. 21.
    Ito M, Hayashi K, Ishida Y, Uetani M, Yamada M, Ohki M, Nakanuta T (1997) Discrimination of spinal fracture with various bone mineral measurements. Calcif Tissue Int 60:11–15PubMedCrossRefGoogle Scholar
  22. 22.
    Genant HK, Jergas M (2003) Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int 14(Suppl 3):S43–S55PubMedGoogle Scholar
  23. 23.
    Lechleitner P, Krimbacher E, Genser N, Fridrich L, zur Nedden D, Helweg G, Koenig P, Joannidis M (1994) Bone mineral densitometry in dialyzed patients: quantitative computed tomography versus dual photon absorptiometry. Bone 15:387–391PubMedCrossRefGoogle Scholar
  24. 24.
    Chertow GM, Raggi P, Chasan-Taber S, Bommer J, Holzer H, Burke SK (2004) Determinants of progressive vascular calcification in haemodialysis patients. Nephrol Dial Transplant 19:1489–1496PubMedCrossRefGoogle Scholar
  25. 25.
    Raggi P, Bellasi A, Ferramosca E, Block GA, Muntner P (2007) Pulse wave velocity is inversely related to vertebral bone density in hemodialysis patients. Hypertension 49:1278–1284PubMedCrossRefGoogle Scholar
  26. 26.
    Duan Y, De Luca V, Seeman E (1999) Parathyroid hormone deficiency and excess: similar effects on trabecular bone but differing effects on cortical bone. J Clin Endocrinol Metab 84:718–722PubMedCrossRefGoogle Scholar
  27. 27.
    Jamal SA, Gilbert J, Gordon C, Bauer DC (2006) Cortical pQCT measures are associated with fractures in dialysis patients. J Bone Miner Res 21:543–548PubMedCrossRefGoogle Scholar
  28. 28.
    O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018PubMedCrossRefGoogle Scholar
  29. 29.
    Heaf J (2001) Causes and consequences of adynamic bone disease. Nephron 88:97–106PubMedCrossRefGoogle Scholar
  30. 30.
    Coen G, Ballanti P, Bonucci E, Calabria S, Centorrino M, Fassino V, Manni M, Mantella D, Mazzaferro S, Napoletano I, Sardella D, Taggi F (1998) Bone markers in the diagnosis of low turnover osteodystrophy in haemodialysis patients. Nephrol Dial Transplant 13:2294–2302PubMedCrossRefGoogle Scholar
  31. 31.
    Bervoets AR, Spasovski GB, Behets GJ, Dams G, Polenakovic MH, Zafirovska K, Van Hoof VO, De Broe ME, D’Haese PC (2003) Useful biochemical markers for diagnosing renal osteodystrophy in predialysis end-stage renal failure patients. Am J Kidney Dis 41:997–1007PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer 2009

Authors and Affiliations

  • Jan Mares
    • 1
    Email author
  • Kristina Ohlidalova
    • 2
  • Sylvie Opatrna
    • 1
  • Jiri Ferda
    • 2
  1. 1.Department of Internal MedicineCharles University Teaching Hospital in PilsenPilsenCzech Republic
  2. 2.Department of RadiologyCharles University Teaching Hospital in PilsenPilsenCzech Republic

Personalised recommendations