Incidence of bone fractures among patients on maintenance hemodialysis

Abstract

Background

Patients with chronic kidney disease, especially those undergoing hemodialysis (HD), have a higher risk of fragility fractures. However, the magnitude of the problem and risk factors associated with fracture incidence have not been well studied in the Kingdom of Saudi Arabia.

Methods

This multicenter retrospective study involved HD centers in Jeddah from 2015 to 2021. This study included all adult HD patients. Patient demographics, medication usage, and clinical and biochemical parameters were collected from the registry records.

Results

The study included 328 patients on HD, with a mean age of 53 years. The median duration of HD was 47 months. Osteoporosis was found in 9% of the patients, and 8% had a previous parathyroidectomy. Over the observation period, fractures occurred in 32 patients, with an incidence rate of 20 case/1000 end stage kidney disease patients-year. Patients with fractures had a higher rate of osteoporosis, underwent more parathyroidectomy, had longer HD vintage, and higher bone-specific alkaline phosphatase (BSAP) levels. BSAP was the most significant predictor of fracture incidence in the regression analysis. Using a BSAP cutoff value of 96.6 µg/L, the sensitivity and specificity to predict fractures were 81.8% and 49%, respectively.

Conclusion

The main risk factors for incident fractures were osteoporosis, previous parathyroidectomy, longer HD vintage, and higher BSAP level. A higher BSAP score was the most significant predictor of incident fractures. This may highlight the importance of monitoring bone turnover markers and the negative impact of high bone turnover on patient health.

Keywords:

• Bone
• fractures
• kidney
• hemodialysis
• CKD
• bone-specific alkaline phosphatase

Acknowledgments

The authors acknowledge the contributions of Falwah Abdulrahman Fatani and Talah Khalid Magadmi from the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and was approved by the IRB Committee (IRB Number: H-02-K-076-0320-270 AFFAIRS OFFICE).

Author contributions

Conceptualization, A.K.; methodology, M.A.; software, F.A.O. and N.A.A.; resources, A.K.; data curation, N.H.A, B.A.A, and A.F.A.; writing—original draft preparation, M.A.; writing—review and editing, E.N.; supervision, A.K and M.A. All authors have read and agreed to the published version of the manuscript.

Disclosure statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Data availability statement

The dataset for this study is available upon request from the corresponding author.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.