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. 2021 May 20;16(5):e0251912.
doi: 10.1371/journal.pone.0251912. eCollection 2021.

Impact of serum magnesium and bone mineral density on systemic fractures in chronic hemodialysis patients

Mayuko Hori  1 , Kaoru Yasuda  1 , Hiroshi Takahashi  2 , Chikao Yamazaki  3 , Kunio Morozumi  1 , Shoichi Maruyama  4
Affiliations

Impact of serum magnesium and bone mineral density on systemic fractures in chronic hemodialysis patients

Mayuko Hori et al. PLoS One. .

Abstract

Introduction: Bone mineral density (BMD) measured with dual-energy X-ray absorptiometry (DXA) can be used to predict fractures, but its clinical utility has not been fully established in chronic kidney disease (CKD) patients. Magnesium is an essential trace element. Although magnesium is associated with the risk of fractures in non-CKD populations, the relationship is unknown in CKD patients.

Methods: BMD and serum magnesium levels were measured in 358 stable outpatients undergoing maintenance hemodialysis therapy. The primary outcome was fragility fracture. Patients were divided into groups according to the median level of magnesium and the normal threshold value of lumbar spine BMD.

Results: During the median follow-up period of 36 months, 36 (10.0%) fractures occurred. The cumulative incidence rates of fractures were 17.6% and 5.2% [adjusted hazard ratio (aHR) 2.31, 95% confidence interval (CI) 1.03-5.17, P = 0.030] in the lower (<2.6 mg/dL) and higher (≥2.6 mg/dL) magnesium (Mg) groups, respectively, and 21.2% and 7.3% (aHR 2.59, 95% CI 1.09-6.16, P = 0.027) in the low- and high-BMD groups, respectively. The lower-Mg and low-BMD group had a 9.21-fold higher risk of fractures (95% CI; 2.35-47.00; P = 0.0010) than the higher-Mg and high-BMD group. Furthermore, adding both magnesium levels and lumbar spine BMD levels to the established risk factors significantly improved the prediction of fractures (C-index: 0.784 to 0.830, p = 0.041).

Discussion/conclusions: The combination of serum magnesium and lumbar spine BMD can be used for fracture risk stratification and synergistically improves the prediction of fractures in CKD patients.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier cumulative incidence curves for fractures according to the groups.
(A) Stratified by the magnesium level. (B) Stratified by L2-L4 BMD.
Fig 2
Fig 2. Kaplan-Meier cumulative incidence curves for fractures stratified by both the magnesium level and L2-L4 BMD.
See this image and copyright information in PMC

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