Abstract
The aim of this study was to assess the clinical and laboratory correlations of bone mineral density (BMD) measurements among a large population of patients on chronic peritoneal dialysis (PD). This cross-sectional, multicenter study was carried out in 292 PD patients with a mean age of 56 ± 16 years and mean duration of PD 3.1 ± 2.1 years. Altogether, 129 female and 163 male patients from 24 centers in Canada, Greece, and Turkey were included in the study. BMD findings, obtained by dual-energy X-ray absorptiometry (DEXA) and some other major clinical and laboratory indices of bone mineral deposition as well as uremic osteodystrophy were investigated. In the 292 patients included in the study, the mean lumbar spine T-score was −1.04 ± 1.68, the lumbar spine Z-score was −0.31 ± 1.68, the femoral neck T-score was −1.38 ± 1.39, and the femoral neck Z score was −0.66 ± 1.23. According to the WHO criteria based on lumbar spine T-scores, 19.2% of 292 patients were osteoporotic, 36.3% had osteopenia, and 44.4% had lumbar spine T-scores within the normal range. In the femoral neck area, the prevalence of osteoporosis was slightly higher (26%). The prevalence of osteoporosis was 23.3% in female patients and 16.6% in male patients with no statistically significant difference between the sexes. Agreements of lumbar spine and femoral neck T-scores for the diagnosis of osteoporosis were 66.7% and 27.3% and 83.3% for osteopenia and normal BMD values, respectively. Among the clinical and laboratory parameters we investigated in this study, the body mass index (BMI) (P < 0.001), daily urine output, and urea clearance time × dialysis time/volume (Kt/V) (P < 0.05) were statistically significantly positive and Ca × PO4 had a negative correlation (P < 0.05) with the lumbar spine T scores. Femoral neck T scores were also positively correlated with BMI, daily urine output, and KT/V; and they were negatively correlated with age. Intact parathyroid hormone levels did not correlate with any of the BMD parameters. Femoral neck Z scores were correlated with BMI (P < 0.001), and ionized calcium (P < 0.05) positively and negatively with age, total alkaline phosphatase (P < 0.05), and Ca × P (P < 0.01). The overall prevalence of fractures since the initiation of PD was 10%. Our results indicated that, considering their DEXA-based BMD values, 55% of chronic PD patients have subnormal bone mass—19% within the osteoporotic range and 36% within the osteopenic range. Our findings also indicate that low body weight is the most important risk factor for osteoporosis in chronic PD patients. An insufficient dialysis dose (expressed as KT/V) and older age may also be important risk factors for osteoporosis of PD patients.
Similar content being viewed by others
References
SA Jamal C Chase YI Goh R Rıchardson GA Hawker (2002) ArticleTitleBone density and heel ultrasound testing do not identify patients with dialysis-dependent renal failure who had fractures Am J Kidney Dis 39 843–849 Occurrence Handle11920352
K Atsumi K Kushida K Yamazaki S Shimizu A Ohmura T Inoue (1999) ArticleTitleRisk factors for vertebral fractures in renal osteodystrophy Am J Kidney Dis 33 287–293 Occurrence Handle10023640 Occurrence Handle1:STN:280:DyaK1M7ks1antw%3D%3D
M Coco H Rush (2000) ArticleTitleIncreased incidence of hip fractures in dialysis patients with low serum parathyroid hormone Am J Kidney Dis 36 1115–1121 Occurrence Handle11096034 Occurrence Handle1:STN:280:DC%2BD3M%2FnslWrtA%3D%3D
SN Davison (2003) ArticleTitlePain in hemodialysis patients: prevalence, cause, severity and management Am J Kidney Dis 42 1239–1247 Occurrence Handle14655196 Occurrence Handle10.1053/j.ajkd.2003.08.025
MW Taal T Masud D Gren MJ Cassidy (1999) ArticleTitleRisk factors for reduced bone density in hemodialysis patients Nephrol Dial Transplant 14 1922–1928 Occurrence Handle10462272 Occurrence Handle1:STN:280:DyaK1MzovFelug%3D%3D
CO Stehman-Breen D Sherrard A Walker R Sadler A Alem J Lindberg (1999) ArticleTitleRacial differences in bone mineral density and bone loss among end-stage renal disease patients Am J Kidney Dis 33 941–946 Occurrence Handle10213653 Occurrence Handle1:STN:280:DyaK1M3jtVWltQ%3D%3D
VM Brandenburg M Ketteler WJ Fassbender N Heussen T Freuding J Floege TH Ittel (2002) ArticleTitleDevelopment of lumbar spine bone mineral density in the course after kidney transplantation Am J Kidney Dis 40 1066–1074 Occurrence Handle12407653 Occurrence Handle10.1053/ajkd.2002.36345
U Barnas A Schmidt G Seidl A Kaider P Pietschmann G Mayer (2001) ArticleTitleA 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 1247–1252 Occurrence Handle11382695 Occurrence Handle1:STN:280:DC%2BD3M3pvFWmsQ%3D%3D Occurrence Handle10.1053/ajkd.2001.24529
D Baszko-Blaszyk AE Grzegorzewska W Horst-Sikorska J Sowinski (2001) ArticleTitleBone mass in chronic renal insufficiency patients treated with continuous ambulatory peritoneal dialysis Adv Perit Dial 17 109–113 Occurrence Handle11510255 Occurrence Handle1:STN:280:DC%2BD3MvmsFyqsw%3D%3D
BP Balon R Hojs A Zavratnik M Kos (2002) ArticleTitleBone mineral density in patients beginning hemodialysis treatment Am J Nephrol 22 14–17
DW Johnson HD McIntyre A Brown J Freeman RJ Rigby (1996) ArticleTitleThe role of DEXA bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients Perit Dial Int 16 34–40 Occurrence Handle8616170 Occurrence Handle1:STN:280:BymB3cvmsVU%3D
P Passadakis E Thodis J Manavis S Panagoutsos V Vargemezis (1995) ArticleTitleThe identification of bone mineral density in CAPD in comparison with HD patients Adv Perit Dial 12 247–253
InstitutionalAuthorNameWHO (1994) Assesment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis: Report of World Health Organization Study Group World Health Organization Geneva
P Ureña O Poenaru-Bernard A Ostertag C Baudoin M Cohen-Solal T Cantor M Christine de Vernejoul (2003) ArticleTitleBone mineral density, biochemical markers and skeletal fractures in hemodialysis patients Nephrol Dial Transplant 18 2325 Occurrence Handle14551361
ZH Han S Palnitkar DS Rao D Nelson AM Parfitt (1997) ArticleTitleEffects of etnicity and age or menopause on the remodeling turnover of iliac bone: implications for mechanisms of bone loss J Bone Miner Res 12 498–508 Occurrence Handle9101361 Occurrence Handle1:STN:280:ByiB2MngtlQ%3D
SF Lei FY Deng MX Li V Dvorayk HW Deng (2003) ArticleTitleBone mineral density in elderly Chinese: effects of age, sex, weight, height and body mass index J Bone Miner Metab 22 71–78
ER Brooks D Heltz P Wozniak C Partington JC Lovejoy (1998) ArticleTitleLateral spine densitometry in obese women Calcif Tissue Int 63 173–176 Occurrence Handle9685525 Occurrence Handle10.1007/s002239900510 Occurrence Handle1:CAS:528:DyaK1cXkvFWksr4%3D
J Cunningham SM Sprague J Cannata-Andia M Coco M Cohen-Solal L Fitzpatrick D Golzmann MH Lafage-Proust M Leonard S Ott M Rodriguez C Stehman-Breen P Stern J Welsinger (2004) ArticleTitleOsteoporosis in chronic kidney disease Am J Kidney Dis 43 566–571 Occurrence Handle14981616 Occurrence Handle10.1053/j.ajkd.2003.12.004
S Takata T Ikata H Yonezu (1999) ArticleTitleCharacteristics of bone mineral density and soft tissue composition of obese Japanese women: application of dual-energy X-ray absorptiometry J Bone Miner Metab 17 206–210 Occurrence Handle10757681 Occurrence Handle10.1007/s007740050086 Occurrence Handle1:STN:280:DC%2BD3c3hvVKgsg%3D%3D
Y Nishizawa H Koyama T Shoji H Aratani S Hagiwara T Miki H Morii (1991) ArticleTitleObesity as a determinant of regional bone mineral density J Nutr Sci Vitaminol 37 S65–S70 Occurrence Handle1820447
CO Stehman-Breen DJ Sherrard AM Alem DL Gillen SR Heckbert CS Wong A Ball NS Weiss (2000) ArticleTitleRisk factors for hip fracture among patients with end-stage renal disease Kidney Int 58 2200–2205 Occurrence Handle11044242 Occurrence Handle10.1111/j.1523-1755.2000.00394.x Occurrence Handle1:STN:280:DC%2BD3M%2FivFSqsQ%3D%3D
E Boling C Primavera G Friedman M King L Bosserman E Schulz W Goodman (1993) ArticleTitleNoninvasive measurements of bone mass in adult renal osteodystrophy Bone 14 409–413 Occurrence Handle8363886 Occurrence Handle10.1016/8756-3282(93)90172-7 Occurrence Handle1:STN:280:ByyA2s7ovFc%3D
A Hutchison R Whitehouse H Boulton J Adams E Mawer T Freemont R Gokal (1993) ArticleTitleCorrelation of bone histology with parathyroid hormone, vitamin D3, and radiology in end stage renal disease Kidney Int 44 1071–1077 Occurrence Handle8264137 Occurrence Handle1:CAS:528:DyaK2cXitFCntrY%3D
G Eknoyan A Levin NW Levin (2003) ArticleTitleBone metabolism and disease in chronic kidney disease Am J Kidney Dis 42 IssueIDSuppl 3 S1–S201
T Saisu Y Wakabayashi K Yamada T Shigematsu S Goto M Nishimura Y Miura H Nakano H Moriya (2000) ArticleTitleEffect of low-calcium hemodialysate on bone metabolism J Bone Miner Metab 18 57–62 Occurrence Handle10701159 Occurrence Handle10.1007/s007740050012 Occurrence Handle1:CAS:528:DC%2BD3cXjtlKlurc%3D
MA Fontaine A Albert B Dubois A Saint-Remy G Rorive (2000) ArticleTitleFracture and bone mineral density in hemodialysis patients Clin Nephrol 54 218–226 Occurrence Handle11020020 Occurrence Handle1:STN:280:DC%2BD3cvmsVyntQ%3D%3D
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ersoy, F., Passadakis, S., Tam, P. et al. Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients. J Bone Miner Metab 24, 79–86 (2006). https://doi.org/10.1007/s00774-005-0650-3
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00774-005-0650-3