Interrelationships between sarcopenia, bone turnover markers and low bone mineral density in patients on hemodialysis

Abstract

Background

Hemodialysis (HD) patients are at risk for sarcopenia (SP) and bone loss, which may impact falls and bone fragility and lead to poor prognosis. Patients with HD and those with osteoporosis (OP) are still underdiagnosed and untreated. The aims of the present study were to evaluate the factors that affect bone mineral density (BMD) loss in HD patients, and explore traditional and novel approaches to manage chronic kidney disease–mineral-bone disorder (CKD-MBD).

Methods

Patients who underwent regular HD at the First Affiliated Hospital of Soochow University were retrospectively evaluated. According to the WHO osteoporosis criteria, patients were categorized into three groups: normal BMD, osteopenia, and osteoporosis. Demographic and clinical data, skeletal muscle mass, and bone turnover markers(BTM) were compared between the three groups. The correlation between bone density and muscle mass was calculated, and related risk factors were analyzed.

Results

This study enrolled 130 HD patients, 36 patients were diagnosed with sarcopenia (27.7%), 44 patients were diagnosed with osteopenia (33.8%), 19 patients were diagnosed with osteoporosis (14.6%), and 23 patients were diagnosed with osteosarcopenia (17.7%). The SMI was positively correlated with the BMD of the lumbar spine (r = 0.23, p < 0.01) and femoral neck (r = 0.22, p < 0.05). In ordinal logistic regression analysis, the odds ratio (OR) for low BMD was high for patients with sarcopenia (OR = 5.894, 95% CI 1.592–21.830, p < 0.01), older age (OR = 1.095, 95% CI 1.041–1.153, p < 0.001), higher TRACP-5b levels (OR = 1.597, 95% CI 1.230–2.072, p < 0.01), and lower 25-OH vitamin D levels (OR = 0.631, 95% CI 0.544–0.733, p < 0.001).

Conclusion

The preservation of skeletal muscle mass could be important to prevent a BMD decrease in HD patients. Adequate intake of vitamin D and control of TRACP-5b levels will help reduce the occurrence and progression of osteopenia/sarcopenia in HD patients.

Keywords:

• Bone mineral density
• skeletal muscle mass index
• hemodialysis
• sarcopenia
• osteoporosis
• osteosarcopenia

Author contributions

The study was designed by Yilin Wang collected, interpreted data, drafted, and revised the manuscript. Wen xia Ma analysised data. Fenglin Chen and Jianhong Pu both critically revised the manuscript, supervised the research group, and ensured the integrity of the data.

Ethical approval

The study was approved by the human ethics committee of each participating hemodialysis dialysis center and was in line with the ethical principles of the 1964 Helsinki declaration. This study was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University(2022-160).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Health Care Issues for Cadres in Jiangsu Province (BJ2009). This work was also supported by the First Affiliated Hospital of Soochow University.