Incidence of bone fractures among patients on maintenance hemodialysis

Figures & data

Table 1. Demographic and clinical parameters of the studied patients.

	All (n = 328)
Age, years	53.53 ± 15.18
	56(19-95)
Gender:
Male n(%)	183(55.8%)
Female n(%)	145(44.2%)
Hemodialysis duration, months	46.5(3-501)
BMI, kg/m^2	35.98 ± 6.26
Hypertension	302(92.1%)
Diabetes mellitus	146(44.5%)
IHD	35(10.7%)
CVD	100(30.5%)
Hyperlipidemia	38(11.6%)
Osteoporosis	30(9.1%)
Depression	11(3.4%)
PCKD	5(1.5%)
Hypothyroidism	31 (9.5%)
Charlson comorbidity index	4.09(2-9)
Prior kidney transplantation	36(11%)
Prior parathyroidectomy	27(8.2%)
Drug history:
CCB	270(82.3%)
BB	185(56.4%)
ACEIs/ARBs	173(52.7%)
Alpha blockers	118(36%)
Vasodilators	88(26.8%)
Cinacalcet	117(35.7%)
Calcitriol	153(46.6%)
Calcium supplements	322(98.2%)
Sevelamer	301(91.8%)
PPI	158(48.6%)
Anti-seizures	35(10.7%)
Loop diuretics	51(15.6%)
Erythropoietin	176(54%)
Long term glucocorticoids	22(6.7%)
Acetaminophen	12(3.7%)
Aluminum containing antacids	23(7%)

ACEIs/ARBs: Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers, BB: Beta blocker, BMI: Body mass index, CCB: Calcium channel blocker, CVD: Cardiovascular disease, IHD: Ischemic heart disease, PCKD: Polycystic kidney disease, PPI: Protein pump inhibitors.

Data are expressed as n(%), mean ± SD, or median (min-max), as appropriate.

Table 2. Laboratory data of the studied patients.

	All (n = 328)
Serum albumin, gm/dl	4.05 ± 0.28
BSAP, µg/L	100.19(5.06-875)
Serum calcium, mg/dl	8.90 ± 0.49
Ferritin, ng/mL	468.30(23.43-2158.94)
Hemoglobin, gm/dl	10.96 ± 0.84
Serum phosphorus, mg/dl	5.02 ± 1.32
iPTH, pg/ml	577 (14.96–2500)
25(OH) D3 ng/mL	15.08(7.07-38.28)

BSAP: Bone-specific alkaline phosphatase, iPTH: intact parathyroid hormone.

Data are expressed as mean ± SD or median (min-max), as suitable.

Table 3. Demographic and clinical parameters of the patients with and without fractures.

	Patients without fracture (n = 296)	Patients with fracture (n = 32)	P value
Age, years	53.59 ± 15.14	52.97 ± 15.79	0.826**
	56(19-95)	56(29-95)
Gender:			0.487***
Male n(%)	167(56.4%)	16(50%)
Female n(%)	129(43.65%)	16(50%)
Hemodialysis duration, months	44(3-501)	64(3-455)	0.039**
BMI, kg/m^2	35.89 ± 6.21	36.80 ± 6.71	0.435*
Hypertension	273(92.2%)	29(90.6%)	0.729***
Diabetes mellitus	133(44.9%)	13(40.6%)	0.641***
IHD	29(9.8%)	6(18.8%)	0.181***
CVD	87(29.4%)	13(40.6%)	0.190***
Hyperlipidemia	36(12.2%)	2(6.3%)	0.321***
Osteoporosis	23(7.8%)	7(21.9%)	0.009***
Depression	9(3%)	2(6.3%)	0.338***
PKD	4(1.4%)	1(3.1%)	0.403***
Hypothyroidism	27(9.1%)	4(12.5%)	0.535***
Charlson comorbidity index	4(2-9)	4(2-7)	0.840**
Prior kidney transplantation	31(10.5%)	5(15.6%)	0.376***
Prior parathyroidectomy	21(7.1%)	6(18.8%)	0.023***
Drug history:
CCB	245(82.8%)	25(78.1%)	0.513***
BB	165(55.7%)	20(62.5%)	0.464***
ACEI/ARBs	155(52.4%)	18(56.3%)	0.676***
Alpha blockers	107(36.1%)	11(34.4%)	0.843***
Vasodilators	81(27.4%)	7(21.9%)	0.506***
Cinacalcet	102(34.5%)	15(46.9%)	0.164***
Calcitriol	138(46.6%)	15(46.9%)	0.978***
Calcium supplements	291(98.3%)	31(96.9%)	0.565***
Sevelamer	272(91.9%)	29(90.6%)	0.804***
PPI	139(47.1%)	20(62.5%)	0.098***
Anti-seizures	29(9.8%)	6(18.8%)	0.121***
Loop diuretics	46(15.6%)	5(15.6%)	0.996***
Erythropoietin	160(54.1%)	17(53.1%)	0.153***
Long term glucocorticoids	20(6.8%)	2(6.3%)	0.913***
Acetaminophen	12(4.1%)	0	0.616***
Aluminum containing antacids	23(7.8%)	0	0.146***

ACEIs/ARBs: Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers, BB: Beta blocker, BMI: Body mass index, CCB: Calcium channel blocker, CVD: Cardiovascular disease, IHD: Ischemic heart disease, PKD: Polycystic kidney disease, PPI: Protein pump inhibitors.

Data are expressed as n(%), mean ± SD, or median (min-max), as appropriate.

*P value was computed using an independent t-test.

**P value was computed by Mann–Whitney U-test.

***P value was computed by Chi-Square test.

Table 4. Laboratory data of the patients with and without fractures.

	Patients without fracture (n = 296)	Patients with fracture (n = 32)	P value
Serum albumin, gm/dl	4.06 ± 0.275	4.01 ± 0.40	0.423*
BSAP, µg/L	97.56(5.06–631.75)	131.25(42.25–875)	0.011**
Serum calcium, mg/dl	8.90 ± 0.47	8.93 ± 0.65	0.796*
Ferritin, ng/mL	469.56(50.89–2158.94)	438.77(23.43–1076.41)	0.846**
Hemoglobin, gm/dl	10.95 ± 0.85	11.04 ± 0.62	0.629*
Serum phosphorus, mg/dl	5.01 ± 1.32	5.07 ± 1.36	0.840*
iPTH, pg/ml	574.24(14.96–2447)	603.16(134.7–2500)	0.855**
25(OH) D3	14.93(7.07–33)	16.40(9.04–38.28)	0.465**

BSAP: Bone-specific alkaline phosphatase, iPTH: intact parathyroid hormone.

Data are expressed as mean ± SD or median (min-max), as suitable.

*P value was computed using an independent t-test.

**P value was computed by Mann-Whitney U test.

Figure 1. ROC curve of BSAP as a predictor of risk of fracture.

Table 5. Independent predictors of fractures.

	B	P value.	OR	95% C.I. for EXP(B)
				Lower	Upper
BSAP	0.004	0.013	1.004	1.001	1.007
Hemodialysis duration	0.003	0.285	1.003	0.998	1.007
Osteoporosis	−0.511	0.454	0.600	0.157	2.286
Prior parathyroidectomy	−0.601	0.386	0.548	0.141	2.131

BSAP: Bone-specific alkaline phosphatase.

Data availability statement

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