Review

. 2023 Feb 17:10:20543581231154183.

doi: 10.1177/20543581231154183. eCollection 2023.

Magnesium and Fracture Risk in the General Population and Patients Receiving Dialysis: A Narrative Review

Andrea C Cowan¹, Kristin K Clemens², Jessica M Sontrop³, Stephanie N Dixon^{3

4}, Lauren Killin⁵, Sierra Anderson⁵, Rey R Acedillo⁶, Amit Bagga⁷, Clara Bohm^{8

9}, Pierre Antoine Brown¹⁰, Brenden Cote¹¹, Varun Dev¹², Claire Harris¹³, Swapnil Hiremath¹⁴, Mercedeh Kiaii¹⁵, Eduardo Lacson Jr¹⁶, Amber O Molnar¹⁷, Matthew J Oliver¹⁸, Malvinder S Parmar¹⁹, Jennifer M McRae²⁰, Bharat Nathoo²¹, Kathleen Quinn²², Nikhil Shah²³, Samuel A Silver²⁴, Daniel J Tascona²⁵, Stephanie Thompson²⁶, Robert H Ting²⁷, Marcello Tonelli²⁸, Hans Vorster²⁹, Davinder B Wadehra³⁰, Ron Wald³¹, Myles Wolf³², Amit X Garg¹

Affiliations

¹ Division of Nephrology, Department of Medicine, Victoria Hospital, London Health Sciences Centre, ON, Canada.
² Division of Endocrinology, Department of Medicine, St. Joseph's Hospital, London, ON, Canada.
³ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁴ Lawson Health Research Institute, London Health Sciences Centre, ON, Canada.
⁵ ICES Western, London, ON, Canada.
⁶ Department of Medicine, Thunder Bay Regional Health Sciences Centre, ON, Canada.
⁷ Windsor Regional Hospital, ON, Canada.
⁸ Chronic Disease Innovation Centre, Winnipeg, MB, Canada.
⁹ University of Manitoba, Winnipeg, Canada.
¹⁰ Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada.
¹¹ Patient Partner, London Health Sciences Centre, ON, Canada.
¹² Humber River Hospital, Toronto, ON, Canada.
¹³ Division of Nephrology, Department of Medicine, Vancouver General Hospital, The University of British Columbia, Canada.
¹⁴ Department of Medicine, University of Ottawa, ON, Canada.
¹⁵ Division of Nephrology, Department of Medicine, St. Paul's Hospital, Vancouver, BC, Canada.
¹⁶ Division of Nephrology, Tufts University School of Medicine, Boston, MA, USA.
¹⁷ Department of Medicine, St Joseph's Healthcare Hamilton, ON, Canada.
¹⁸ Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
¹⁹ Department of Medicine, Timmins and District Hospital, ON, Canada.
²⁰ Division of Nephrology, Department of Medicine, University of Calgary, AB, Canada.
²¹ Mackenzie Health, Richmond Hill, ON, Canada.
²² Niagara Health System, St. Catharines, ON, Canada.
²³ University of Alberta, Edmonton, Canada.
²⁴ Division of Nephrology, Kingston Health Sciences Center, Queen's University, ON, Canada.
²⁵ Orillia Soldiers' Memorial Hospital, ON, Canada.
²⁶ Division of Nephrology, University of Alberta, Edmonton, Canada.
²⁷ University of Toronto, ON, Canada.
²⁸ Cumming School of Medicine, University of Calgary, AB, Canada.
²⁹ Can-SOLVE CKD Network, Vancouver, BC, Canada.
³⁰ William Osler Health System, Etobicoke, ON, Canada.
³¹ Division of Nephrology, St. Michael's Hospital, University of Toronto, ON, Canada.
³² Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.

PMID: 36814964
PMCID: PMC9940170
DOI: 10.1177/20543581231154183

Review

Magnesium and Fracture Risk in the General Population and Patients Receiving Dialysis: A Narrative Review

Andrea C Cowan et al. Can J Kidney Health Dis. 2023.

. 2023 Feb 17:10:20543581231154183.

doi: 10.1177/20543581231154183. eCollection 2023.

Authors

Affiliations

¹ Division of Nephrology, Department of Medicine, Victoria Hospital, London Health Sciences Centre, ON, Canada.
² Division of Endocrinology, Department of Medicine, St. Joseph's Hospital, London, ON, Canada.
³ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁴ Lawson Health Research Institute, London Health Sciences Centre, ON, Canada.
⁵ ICES Western, London, ON, Canada.
⁶ Department of Medicine, Thunder Bay Regional Health Sciences Centre, ON, Canada.
⁷ Windsor Regional Hospital, ON, Canada.
⁸ Chronic Disease Innovation Centre, Winnipeg, MB, Canada.
⁹ University of Manitoba, Winnipeg, Canada.
¹⁰ Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada.
¹¹ Patient Partner, London Health Sciences Centre, ON, Canada.
¹² Humber River Hospital, Toronto, ON, Canada.
¹³ Division of Nephrology, Department of Medicine, Vancouver General Hospital, The University of British Columbia, Canada.
¹⁴ Department of Medicine, University of Ottawa, ON, Canada.
¹⁵ Division of Nephrology, Department of Medicine, St. Paul's Hospital, Vancouver, BC, Canada.
¹⁶ Division of Nephrology, Tufts University School of Medicine, Boston, MA, USA.
¹⁷ Department of Medicine, St Joseph's Healthcare Hamilton, ON, Canada.
¹⁸ Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
¹⁹ Department of Medicine, Timmins and District Hospital, ON, Canada.
²⁰ Division of Nephrology, Department of Medicine, University of Calgary, AB, Canada.
²¹ Mackenzie Health, Richmond Hill, ON, Canada.
²² Niagara Health System, St. Catharines, ON, Canada.
²³ University of Alberta, Edmonton, Canada.
²⁴ Division of Nephrology, Kingston Health Sciences Center, Queen's University, ON, Canada.
²⁵ Orillia Soldiers' Memorial Hospital, ON, Canada.
²⁶ Division of Nephrology, University of Alberta, Edmonton, Canada.
²⁷ University of Toronto, ON, Canada.
²⁸ Cumming School of Medicine, University of Calgary, AB, Canada.
²⁹ Can-SOLVE CKD Network, Vancouver, BC, Canada.
³⁰ William Osler Health System, Etobicoke, ON, Canada.
³¹ Division of Nephrology, St. Michael's Hospital, University of Toronto, ON, Canada.
³² Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.

PMID: 36814964
PMCID: PMC9940170
DOI: 10.1177/20543581231154183

Abstract
in English, French

Purpose of review: Magnesium is an essential mineral for bone metabolism, but little is known about how magnesium intake alters fracture risk. We conducted a narrative review to better understand how magnesium intake, through supplementation, diet, or altering the concentration of dialysate magnesium, affects mineral bone disease and the risk of fracture in individuals across the spectrum of kidney disease.

Sources of information: Peer-reviewed clinical trials and observational studies.

Methods: We searched for relevant articles in MEDLINE and EMBASE databases. The methodologic quality of clinical trials was assessed using a modified version of the Downs and Black criteria checklist.

Key findings: The role of magnesium intake in fracture prevention is unclear in both the general population and in patients receiving maintenance dialysis. In those with normal kidney function, 2 meta-analyses showed higher bone mineral density in those with higher dietary magnesium, whereas 1 systematic review showed no effect on fracture risk. In patients receiving maintenance hemodialysis or peritoneal dialysis, a higher concentration of dialysate magnesium is associated with a lower concentration of parathyroid hormone, but little is known about other bone-related outcomes. In 2 observational studies of patients receiving hemodialysis, a higher concentration of serum magnesium was associated with a lower risk of hip fracture.

Limitations: This narrative review included only articles written in English. Observed effects of magnesium intake in the general population may not be applicable to those with chronic kidney disease particularly in those receiving dialysis.

Justification: Le magnésium est un minéral essentiel pour le métabolisme osseux, mais on en sait peu sur la façon dont un apport en magnésium modifie le risque de fracture. Nous avons procédé à un examen narratif afin de mieux comprendre comment les maladies liées à la densité minérale osseuse et le risque de fracture sont affectés par un apport en magnésium (supplémentation, régime alimentaire ou modification de la concentration de dialysat de magnésium) chez les personnes atteintes d’insuffisance rénale.

Sources: Essais cliniques et études observationnelles examinés par des pairs.

Méthodologie: Nous avons répertorié les articles pertinents dans les bases de données MEDLINE et EMBASE. Une version modifiée des critères de contrôle de la qualité des études de Downs et Black a servi à évaluer la qualité méthodologique des essais cliniques retenus.

Principaux résultats: Le rôle d’un apport en magnésium dans la prévention des fractures n’est pas clair, tant dans la population générale que chez les patients sous dialyse d’entretien. Chez les personnes ayant une fonction rénale normale, deux méta-analyses ont montré que les personnes dont le régime alimentaire est riche en magnésium présentent une densité minérale osseuse plus élevée; alors qu’une revue systématique n’a montré aucun effet sur le risque de fracture. Chez les patients sous hémodialyse d’entretien ou dialyse péritonéale, une concentration plus élevée de dialysat de magnésium est associée à une plus faible concentration d’hormone parathyroïdienne, mais on en sait peu sur les autres effets liés aux os. Dans deux études observationnelles portant sur des patients sous hémodialyse, une concentration plus élevée de magnésium sérique a été associée à un risque plus faible de fracture de la hanche.

Limites: Cet examen narratif ne comprend que des articles rédigés en anglais. Il est possible que les effets d’un apport en magnésium observés dans la population générale ne puissent s’appliquer aux personnes atteintes d’une néphropathie chronique, en particulier aux personnes sous dialyse.

Keywords: fracture; hemodialysis; magnesium; mineral bone disease; parathyroid horomone.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Multifactorial etiology of increased fracture risk in individuals with CKD. *Note.* CKD = chronic kidney disease.

See this image and copyright information in PMC

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Magnesium and Fracture Risk in the General Population and Patients Receiving Dialysis: A Narrative Review

Affiliations

Magnesium and Fracture Risk in the General Population and Patients Receiving Dialysis: A Narrative Review

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

Figures

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References

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Full Text Sources

Research Materials

Abstract in English, French

Conflict of interest statement

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References

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Research Materials

Abstract
in English, French