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Loss of bone mineral density and trabecular bone score in elderly hemodialysis patients: a 2-year follow-up, prospective, single-centre study

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Low bone mineral density (BMD) and trabecular bone score (TBS) are established risk factors for fractures even in hemodialysis population and they seem to be significantly lower in comparison with general population. The aim of our study was to describe 2-year loss of BMD and TBS and their predictors in hemodialysis patients.


From 59 non-selected patients (mean age 67.6 ± 13.1 years) from one dialysis centre, treated with hemodiafiltration (HDF), clinical and laboratory characteristics were obtained and densitometry examinations (with BMD and TBS results) were performed initially and at the end of 2-year follow-up.


Two-year decrease in BMD of lumbar spine reached 4.1% (ns), of proximal femur 9.1% (p = 0.004), and of femoral neck 1.3% (ns). In the co-educated cohort, BMD decrease in all the sites correlated significantly with age and only the change of BMD of lumbar spine was negatively associated with serum calcium (r = − 0.39; p = 0.04) and dialysis vintage (r = − 0.387; p = 0.062), no other predictors of BMD loss were identified. Some predictors of BMD loss were identified with regard to gender. TBS decrease was 0.05 (3.9%; p = 0.03), and similarly, it was not predicted by any of selected parameters. No differences in BMD changes or TBS were observed between the patients with and without fractures.


In patients with HDF, significant BMD and TBS annual losses were observed, and they were associated only with age and (in BMD of lumbar spine) with serum calcium and dialysis vintage.

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  1. 1.

    Miller PD (2014) Bone disease in CKD: a focus on osteoporosis diagnosis and management. Am J Kidney Dis 64(2):290–304.

  2. 2.

    Brunerová L, Ronová P, Verešová J et al (2016) Osteoporosis and impaired trabecular bone score in hemodialysis patients. Kidney Blood Press Res 41(3):345–354.

  3. 3.

    Moe SM, Nickolas TL (2016) Fractures in patients with CKD: time for action. Clin J Am Soc Nephrol 11(11):1929–1931

  4. 4.

    Pimentel A, Ureña-Torres P, Zillikens MC, Bover J, Cohen-Solal M (2017) Fractures in patients with CKD-diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation. Kidney Int 92(6):1343–1355.

  5. 5.

    Bucur RC, Panjwani DD, Turner L, Rader T, West SL, Jamal SA (2015) Low bone mineral density and fractures in stages 3–5 CKD: an updated systematic review and meta-analysis. Osteoporos Int 26(2):449–458.

  6. 6.

    Moe SM (2017) Renal osteodystrophy or kidney-induced osteoporosis? Curr Osteoporos Rep 15(3):194–197.

  7. 7.

    Brunerova L, Palicka V, Sulkova SD (2018) Commentary on management of osteoporosis in advanced CKD—common view of a nephrologist and a bone specialist. Endocr Pract. ahead of print)

  8. 8.

    Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L et al (2017) 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 92(6):26–36.

  9. 9.

    Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group (2017) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) 2017. Kidney Int Suppl 7:1–59

  10. 10.

    Clarke BL, Khosla S (2010) Physiology of bone loss. Radiol Clin N Am 48(3):483–495.

  11. 11.

    Avramovski P, Sikole A (2012) The progression of bone mineral density loss in dialysis patients compared with the general population. Korean J Intern Med 27(4):436–442.

  12. 12.

    Malluche HH, Monier-Faugere MC, Blomquist G, Davenport DL (2018) Two-year cortical and trabecular bone loss in CKD-5D: biochemical and clinical predictors. Osteoporos Int 29(1):125–134.

  13. 13.

    Shevroja E, Lamy O, Hans D (2018) Review on the utility of trabecular bone score, a surrogate of bone micro-architecture, in the chronic kidney disease spectrum and in kidney transplant recipients. Front Endocrinol (Lausanne) 24(9):561.

  14. 14.

    Yavropoulou MP, Vaios V, Pikilidou M, Chryssogonidis I, Sachinidou M, Tournis S et al (2017) Bone quality assessment as measured by trabecular bone score in patients with end-stage renal disease on dialysis. J Clin Densitom 20(4):490–497.

  15. 15.

    Naylor KL, Prior J, Garg AX, Berger C, Langsetmo L, Adachi JD et al (2016) Trabecular bone score and incident fragility fracture risk in adults with reduced kidney function. Clin J Am Soc Nephrol 11(11):2032–2040

  16. 16.

    Aleksova J, Kurniawan S, Elder GJ (2018) The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease. Osteoporos Int 29(6):1447–1455.

  17. 17.

    Brunerová L, Lažanská R, Kasalický P, Verešová J, Potočková J, Fialová A, Rychlík I (2018) Predictors of bone fractures in a single-centre cohort of hemodialysis patients: a 2-year follow-up study. Int Urol Nephrol 50(9):1721–1728.

  18. 18.

    Leib ES, Lewiecki EM, Binkley N, Hamdy RC, International Society for Clinical Densitometry (2014) Official positions of the International Society for Clinical Densitometry. J Clin Densitom 7(1):1–6

  19. 19.

    World Health Organization, FRAX (2011) Accessed 20 Feb 2019

  20. 20.

    Daly RM, Rosengren BE, Alwis G, Ahlborg HG, Sernbo I, Karlsson MK (2013) Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective population-based study. BMC Geriatr 13:71.

  21. 21.

    West SL, Lok CE, Langsetmo L, Cheung AM, Szabo E, Pearce D, Fusaro M, Wald R, Weinstein J, Jamal SA (2015) Bone mineral density predicts fractures in chronic kidney disease. J Bone Miner Res 30(5):913–919.

  22. 22.

    Iimori S, Mori Y, Akita W, Kuyama T, Takada S, Asai T et al (2012) Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients—a single-centre cohort study. Nephrol Dial Transplant 27(1):345–351

  23. 23.

    Stehman-Breen CO, Sherrard D, Walker A, Sadler R, Alem A, Lindberg J (1999) Racial differences in bone mineral density and bone loss among end-stage renal disease patients. Am J Kidney Dis 33(5):941–946

  24. 24.

    Auguste BL, Yuen D, Chan CT (2016) Conventional hemodialysis is associated with greater bone loss than nocturnal hemodialysis: a retrospective observational study of a convenience cohort. Can J Kidney Health Dis 3:27.

  25. 25.

    Ensrud KE (2013) Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci 68(10):1236–1242.

  26. 26.

    Cawthon PM, Ewing SK, McCulloch CE, Ensrud KE, Cauley JA, Cummings SR, Orwoll ES, Osteoporotic Fractures in Men (MrOS) Research Group (2009) Loss of hip BMD in older men: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res 24(10):1728–1735.

  27. 27.

    Melton LJ 3rd, Khosla S, Atkinson EJ, Oconnor MK, Ofallon WM, Riggs BL (2000) Cross-sectional versus longitudinal evaluation of bone loss in men and women. Osteoporos Int 11(7):592–599

  28. 28.

    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(3):300–308.

  29. 29.

    Toussaint ND, Lau KK, Strauss BJ, Polkinghorne KR, Kerr PG (2008) Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease. Nephrol Dial Transplant 23:586–593

  30. 30.

    Schousboe JT, Vo TN, Langsetmo L, Taylor BC, Kats AM, Schwartz AV, Bauer DC, Cauley JA, Ensrud KE, Osteoporotic Fractures in Men (MrOS) Study Research Group (2018) Predictors of change of trabecular bone score (TBS) in older men: results from the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 29(1):49–59.

  31. 31.

    Sritara C, Thakkinstian A, Ongphiphadhanakul B, Amnuaywattakorn S, Utamakul C, Akrawichien T, Vathesatogkit P, Sritara P (2016) Age-adjusted dual X-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in Thai females and males. J Clin Densitom 19(4):494–501.

  32. 32.

    Dufour R, Winzenrieth R, Heraud A, Hans D, Mehsen N (2013) Generation and validation of a normative, age-specific reference curve for lumbar spine trabecular bone score (TBS) in French women. Osteoporos Int 24(11):2837–2846.

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The publication was supported by PROGRES Q36 by MH CZ-DRO (“Kralovske Vinohrady University Hospital—FNKV, 00064173”). We would like to thank Mr. Michael Allen for language editing.


This study was funded by Progres Q36 and MH CZ-DRO (“Kralovske Vinohrady University Hospital—FNKV, 00064173”).

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Correspondence to Ludmila Brunerová.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Brunerová, L., Kasalický, P., Verešová, J. et al. Loss of bone mineral density and trabecular bone score in elderly hemodialysis patients: a 2-year follow-up, prospective, single-centre study. Int Urol Nephrol 52, 379–385 (2020).

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  • Hemodialysis
  • BMD
  • TBS
  • Loss
  • Follow-up