Risk factors and clinical prediction models for osteoporosis in pre-dialysis chronic kidney disease patients

Abstract

Background

Osteoporosis in pre-dialysis chronic kidney disease (CKD) patients has been overlooked, and the risk factors of osteoporosis in these patients have not been adequately studied.

Objective

To identify risk factors for osteoporosis in pre-dialysis CKD patients and develop predictive models to estimate the likelihood of osteoporosis.

Methods

Dual-energy X-ray absorptiometry was used to measure bone mineral density, and clinical examination results were collected from 326 pre-dialysis CKD patients. Binary logistic regression was employed to explore the risk factors associated with osteoporosis and develop predictive models.

Results

In this cohort, 53.4% (n = 174) were male, 46.6% (n = 152) were female, and 21.8% (n = 71) were diagnosed with osteoporosis. Among those diagnosed with osteoporosis, 67.6% (n = 48) were female and 32.4% (n = 23) were male. Older age and low 25-(OH)-Vitamin D levels were identified as risk factors for osteoporosis in males. For females, older age, being underweight, higher bone alkaline phosphatase (NBAP), and advanced CKD (G5) were significant risk factors, while higher iPTH was protective. Older age, being underweight, and higher NBAP were risk factors for osteoporosis in the G1-4 subgroup. In the G5 subgroup, older age and higher NBAP increased the risk, while high 25-(OH)-Vitamin D or iPTH had protective effects. Nomogram models were developed to assess osteoporosis risk in pre-dialysis patients based on gender and renal function stage.

Conclusion

Risk factors for osteoporosis vary by gender and renal function stages. The nomogram clinical prediction models we constructed may aid in the rapid screening of patients at high risk of osteoporosis.

Keywords:

• Pre-dialysis CKD
• bone mineral density
• CKD mineral bone disorder
• osteoporosis
• bone alkaline phosphatase
• vitamin D

Authors’ contributions

CY. Kuang made significant contributions to the data analysis and manuscript drafting processes. JJ. Shang played a crucial role in the data collection, interpretation, and discussion. MM. Ma, SL. Huang, B. Yan and YZ. Zhong provided valuable assistance in the data collection phase. BZ. Guan and J Gong contributed to the writing and editing of the manuscript. FN. Liu effectively coordinated the project and served as the guarantor. LM. Chen developed the hypothesis, provided joint supervision throughout the project and secured the necessary funding. Furthermore, all authors diligently participated in the revision and editing of the paper.

Ethics approval and consent to participate

Our study received approval from the institutional review board of The First Affiliated Hospital of Jinan University (KY-2023-053) and was registered with the Chinese Clinical Trial Registry (ChiCTR2300068179). All participants signed an informed consent form and agreed to the use of their clinical data for research purposes.

Disclosure statement

The authors declare no competing interests.

Additional information

Funding

This work was supported by 2023 Basic and Applied Basic Research Project of Guangzhou (2023A04J1911) and “the Fundamental Research Funds for the Central Universities” (21622306)