The implication of calf circumference and grip strength in osteoporosis and bone mineral density among hemodialysis patients

Abstract

Background: Chronic kidney disease-mineral and bone disorder (CKD-MBD), nutritional status, and uremia management have been emphasized for bone management in hemodialysis patients. Nevertheless, valuable data on the importance of muscle mass in bone management are limited, including whether conventional management alone can prevent osteoporosis. Thus, the importance of muscle mass and strength, independent of the conventional management in osteoporosis prevention among hemodialysis patients, was evaluated.

Methods: Patients with a history of hemodialysis 6 months or longer were selected. We assessed the risk for osteoporosis associated with calf circumference or grip strength using multivariable adjustment for indices of CKD-MBD, nutrition, and dialysis adequacy. Moreover, the associations between bone mineral density (BMD), calf circumference, grip strength, and bone metabolic markers were also evaluated.

Results: A total of 136 patients were included. The odds ratios (95% confidence interval) for osteoporosis at the femoral neck were 1.25 (1.04-1.54, P < 0.05) and 1.08 (1.00-1.18, P < 0.05) per 1 cm shorter calf circumference or 1 kg weaker grip strength, respectively. Shorter calf circumference was significantly associated with a lower BMD at the femoral neck and lumbar spine (P < 0.001). Weaker grip strength was also associated with lower BMD at the femoral neck (P < 0.01). Calf circumference or grip strength was negatively correlated with bone metabolic marker values.

Conclusion: Shorter calf circumference or weaker grip strength was associated with osteoporosis risk and lower BMD among hemodialysis patients, independent of the conventional therapies.

Keywords: Hemodialysis; Osteoporosis; Sarcopenia.

Fig. 1

Risk for osteoporosis in tertiles based on calf circumference. Adjusted estimated odds ratios (95% confidence intervals) for osteoporosis in tertiles based on calf circumference [i.e., Low ≤ 33.4 vs. 33.5 ≤ Medium ≤ 36.5 vs. 36.6 ≤ High (cm)] are shown. The estimated odds ratios were adjusted for age, sex, history of diabetes, current smoking status, habitual alcohol drinking, hemoglobin, NRI-JH score, iPTH, and Kt/V. iPTH = intact parathyroid hormone; NRI-JH = nutritional risk index for Japanese hemodialysis patients. *P < 0.05

Fig. 2

Scatter plots of the relationships between BMD and calf circumference. Scatter plots of the relationships between BMD at the a femoral neck or b lumbar spine and calf circumference among hemodialysis patients are shown. Each circle represents an individual value. The black lines represent simple linear regression models. The P values were calculated for Pearson’s product–moment correlation coefficients (r-values). BMD bone mineral density

Fig. 3

Scatter plots of the relationships between BMD and grip strength. Scatter plots of the relationships between BMD at the a femoral neck or b lumbar spine and grip strength among hemodialysis patients are shown. Each circle represents an individual value. The black lines represent simple linear regression models. The P-values were calculated for Pearson’s product–moment correlation coefficients (r-values). BMD = bone mineral density

Fig. 4

Scatter plots of the relationships between bone metabolic markers and calf circumference. Scatter plots of the relationships between log-transformed a BALP, b total P1NP, or c TRACP-5b and calf circumference are shown. Each circle represents an individual value. The black lines represent simple linear regression models. The P values were calculated for Pearson’s product–moment correlation coefficients (r-values). BALP = bone-specific alkaline phosphatase; P1NP = type I procollagen N-terminal propeptide; TRACP-5b = tartrate-resistant acid phosphatase 5b