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Association of Reduction in Bone Mineral Density with Mortality in Male Hemodialysis Patients

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Abstract

In the present study we examined the relationship of bone mineral density (BMD) reduction with increased mortality in hemodialysis patients. A single-center prospective observational study was conducted on 269 male hemodialysis patients. The BMD in the distal third of the radius (DR1/3) and in the ultradistal radius (UR), which are enriched with cortical and cancellous bone, respectively, was measured twice using dual-energy X-ray absorptiometry (DXA) with a 1-year interval. Subjects were divided into two groups based on the presence or absence of BMD reduction. Survival was followed for 61.0 months, after which time 104 patients (39%) had died. A significant BMD reduction at the UR and DR1/3 occurred in 182 (68%) and 195 (72%) patients, respectively. Patients with BMD reduction in the UR, in contrast to the DR1/3, had a significantly lower survival rate than those without BMD reduction (P = 0.01). In Cox regression analysis, the rate of BMD change at the UR, in addition to patient age, diabetes mellitus, and serum albumin, emerged as an independent predictor for increased mortality (HR = 0.970, 95% CI 0.945–0.996). Our results suggest that BMD reduction at the UR might be a clinically relevant marker that predicts an increased risk of mortality in male hemodialysis patients.

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References

  1. von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 106:374–375

    Article  Google Scholar 

  2. Baldini V, Mastropasqua M, Francucci CM, D’Erasmo E (2005) Cardiovascular disease and osteoporosis. J Endocrinol Invest 28(10 Suppl):69–72

    PubMed  CAS  Google Scholar 

  3. Kado DM, Browner WS, Blackwell T, Gore R, Cummings SR (2000) Rate of bone loss is associated with mortality in older women: a prospective study. J Bone Miner Res 15:1974–1980

    Article  PubMed  CAS  Google Scholar 

  4. Melamed ML, Eustace JA, Plantinga L, Jaar BG, Fink NE, Coresh J, Klag MJ, Powe NR (2006) Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: a longitudinal study. Kidney Int 70:351–357

    Article  PubMed  CAS  Google Scholar 

  5. Yamada S, Inaba M, Goto H, Nagata M, Ueda M et al (2005) Significance of intima-media thickness in femoral artery in the determination of calcaneus osteo-sono index but not of lumbar spine bone mass in healthy Japanese people. Osteoporos Int 16:64–70

    Article  PubMed  Google Scholar 

  6. Tanaka K, Inaba M, Goto H, Nagata-Sakurai M, Sakai S, Yamada S et al (2006) Paraarticular trabecular bone loss at the ultradistal radius and increased arterial stiffening in postmenopausal patients with rheumatoid arthritis. J Rhueumatol 33:652–658

    Google Scholar 

  7. Okabe R, Inaba M, Sakai S, Ishimura E, Moriguchi A et al (2004) Increased arterial stiffening and thickening in the paretic lower limb in patients with hemiparesis. Clin Sci 106:613–618

    Article  PubMed  Google Scholar 

  8. Neves KR, Graciolli FG, dos Reis LM, Graciolli RG, Neves CL, Magalhaes AO, Custodio MR, Batista DG, Jorgetti V, Moyses RM (2007) Vascular calcification: contribution of parathyroid hormone in renal failure. Kidney Int 71:1262–1270

    Article  PubMed  CAS  Google Scholar 

  9. Okuno S, Ishimura E, Kitatani K, Fujino Y, Kohno K, Maeno Y, Maekawa K (2007) Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients. Am J Kidney Dis 49:417–425

    Article  PubMed  Google Scholar 

  10. Taal MW, Roe S, Masud T, Green D, Porter C, Cassidy MJ (2003) Total hip bone mass predicts survival in chronic hemodialysis patients. Kidney Int 63:1116–1120

    Article  PubMed  Google Scholar 

  11. Negri AL, Barone R, Lombas C, Bogado CE, Zanchetta JR (2006) Evaluation of cortical bone by peripheral quantitative computed tomography in continuous ambulatory peritoneal dialysis patients. Hemodial Int 10:351–355

    Article  PubMed  Google Scholar 

  12. Yajima A, Inaba M, Tominaga Y, Ito A (2007) Minimodeling reduces the rate of cortical bone loss in patients with secondary hyperparathyroidism. Am J Kidney Dis 49:440–451

    Article  PubMed  Google Scholar 

  13. Yajima A, Inaba M, Ogawa Y, Tominaga Y, Tanizawa T, Inou T, Otsubo O (2007) Significance of time-course changes of serum bone markers after parathyroidectomy in patients with uraemic hyperparathyroidism. Nephrol Dial Transplant 22:1645–1657

    Article  PubMed  CAS  Google Scholar 

  14. Maeno Y, Inaba M, Okuno S, Yamakawa T, Ishimura E, Nishizawa Y (2005) Serum concentrations of cross-linked N-telopeptides of type I collagen: new marker for bone resorption in hemodialysis patients. Clin Chem 51:2312–2317

    Article  PubMed  CAS  Google Scholar 

  15. 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 76:256–260

    Article  PubMed  CAS  Google Scholar 

  16. Inaba M, Okuno S, Imanishi Y, Yamada S, Shioi A, Yamakawa T, Ishimura E, Nishizawa Y (2006) Role of fibroblast growth factor-23 in peripheral vascular calcification in non-diabetic and diabetic hemodialysis patients. Osteoporos Int 17:1506–1513

    Article  PubMed  CAS  Google Scholar 

  17. Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, Okamura M, Okada S, Yamakawa T, Ishimura E, Nishizawa Y, Osaka CKD, Expert Research Group (2007) Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol 18:896–903

    Article  PubMed  CAS  Google Scholar 

  18. Baron R (1999) Anatomy and ultrastructure of bone. In: Fravus MJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism. Lippincott Williams & Wilkins, Philadelphia, pp 3–10

  19. Inaba M, Okuno S, Imanishi Y, Ueda M, Yamakawa T, Ishimura E, Nishizawa Y (2005) Significance of bio-intact PTH(1–84) assay in hemodialysis patients. Osteoporos Int 16:517–525

    Article  PubMed  CAS  Google Scholar 

  20. Inaba M, Nagasue K, Okuno S, Ueda M, Kumeda Y, Imanishi Y, Shoji T, Ishimura E, Ohta T, Nakatani T, Kim M, Nishizawa Y (2002) Impaired secretion of parathyroid hormone, but not refractoriness of osteoblast, is a major mechanism of low bone turnover in hemodialyzed patients with diabetes mellitus. Am J Kidney Dis 39:1261–1269

    Article  PubMed  CAS  Google Scholar 

  21. Endres DB, Morgan CH, Garry PJ, Omdahl JL (1987) Age-related changes in serum immunoreactive parathyroid hormone and its biological action in healthy men and women. J Clin Endocrinol Metab 65:724–731

    Article  PubMed  CAS  Google Scholar 

  22. Joborn C, Ljunghall S, Larsson K, Lindh E, Naessén T, Wide L (1991) Skeletal responsiveness to parathyroid hormone in healthy females: relationship to menopause and oestrogen replacement. Clin Endocrinol (Oxf) 34:335–339

    Article  CAS  Google Scholar 

  23. Block GA, Klassen PS, Lazaarus JM, Ofsthun N, Lowrie FG, Chertow GM (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodaialysis. J Am Soc Nephrol 15:2208–2218

    Article  PubMed  CAS  Google Scholar 

  24. Fisher AA, Southcott EK, Srikusalanukul W, Davis MW, Hickman PE, Potter JM, Smith PN (2007) Relationships between myocardial injury, all-cause mortality, vitamin D, PTH, and biochemical bone turnover markers in older patients with hip fractures. Ann Clin Lab Sci 37:222–232

    PubMed  CAS  Google Scholar 

  25. Abe Y, Ejima E, Fujiyama K, Kiriyama T, Ide A, Sera N, Tominaga T, Ashizawa K, Yokoyama N, Eguchi K (2000) Parathyroidectomy for primary hyperparathyroidism induces positive uncoupling and increases bone mineral density in cancellous bones. Clin Endocrinol (Oxf) 52:203–209

    Article  CAS  Google Scholar 

  26. Grzegorzewska AE, Młot-Michalska M (2007) Serum level of intact parathyroid hormone and other markers of bone metabolism in dialyzed patients. Adv Perit Dial 23:162–165

    PubMed  CAS  Google Scholar 

  27. Shoji T, Nishizawa Y (2007) Effects of vitamin D on non-classical target organs and survival. Clin Calcium 17:691–697

    PubMed  CAS  Google Scholar 

  28. Brown AJ, Slatopolsky E (2007) Drug insight: vitamin D analogs in the treatment of secondary hyperparathyroidism in patients with chronic kidney disease. Nat Clin Pract Endocrinol Metab 3:134–144

    Article  PubMed  CAS  Google Scholar 

  29. Baldock PA, Thomas GP, Hodge JM, Baker SU, Dressel U, O’Loughlin PD, Nicholson GC, Briffa KH, Eisman JA, Gardiner EM (2006) Vitamin D action and regulation of bone remodeling: suppression of osteoclastogenesis by the mature osteoblast. J Bone Miner Res 21:1618–1626

    Article  PubMed  CAS  Google Scholar 

  30. Tsukahara H, Nakashima T, Yoshimoto M, Kuriyama M, Shigematsu Y, Hayashi S, Haruki S, Ishii Y, Sudo M (1991) Evaluation of lumbar bone mineral density by dual energy X-ray absorptiometry. Acta Pediatr Jpn 33:459–466

    CAS  Google Scholar 

  31. Miki T, Morita A, Nakatsuka K, Tabata T, Inoue T, Nishizawa Y, Morii H (1997) Changes in bone mineral density at various sites in patients on hemodialysis due to chronic glomerulonephritis. Osteoporos Int 7(Suppl 3):S193–S196

    PubMed  Google Scholar 

  32. Sioka C, Goudevenos J, Pappas K, Bougias C, Papadopoulos A, Grammatikopoulos K, Fotopoulos A (2007) Bone mineral density and coronary atherosclerosis. Calcif Tissue Int 80:301–306

    Article  CAS  Google Scholar 

  33. Yamada S, Inaba M, Goto H, Nagata-Sakurai M, Kumeda Y, Imanishi Y, Emoto M, Ishimura E, Nishizawa Y (2006) Associations between physical activity, peripheral atherosclerosis and bone status in healthy Japanese women. Atherosclerosis 188:196–202

    Article  PubMed  CAS  Google Scholar 

  34. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK (2001) Association of elevated serum PO4, Ca x PO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 12:2131–2138

    PubMed  CAS  Google Scholar 

  35. Sambrook PN, Chen CJ, March L, Cameron ID, Cumming RG, Lord SR, Simpson JM, Seibel MJ (2006) High bone turnover is an independent predictor of mortality in the frail elderly. J Bone Miner Res 21:549–555

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Kaori Kohno, Masaaki Inaba, Senji Okuno, Yoshifumi Maeno, Kiyoshi Maekawa, Tomoyuki Yamakawa, Eiji Ishimura & Yoshiki Nishizawa

  2. Shirasagi Hospital, Osaka, Japan

    Kaori Kohno, Masaaki Inaba, Senji Okuno, Yoshifumi Maeno, Kiyoshi Maekawa, Tomoyuki Yamakawa, Eiji Ishimura & Yoshiki Nishizawa

Authors
  1. Kaori Kohno
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  2. Masaaki Inaba
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  3. Senji Okuno
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  4. Yoshifumi Maeno
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  5. Kiyoshi Maekawa
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  6. Tomoyuki Yamakawa
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  7. Eiji Ishimura
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  8. Yoshiki Nishizawa
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Correspondence to Masaaki Inaba.

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Kohno, K., Inaba, M., Okuno, S. et al. Association of Reduction in Bone Mineral Density with Mortality in Male Hemodialysis Patients. Calcif Tissue Int 84, 180–185 (2009). https://doi.org/10.1007/s00223-008-9206-6

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  • DOI: https://doi.org/10.1007/s00223-008-9206-6

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