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Multicenter Study
. 2023 Dec;45(1):2224456.
doi: 10.1080/0886022X.2023.2224456.

Incidence of bone fractures among patients on maintenance hemodialysis

Abdullah Kashgary  1 , Feryal Omar A Attiah  2 , Nada AbuBakr AlKhateeb  2 , Nada H Abdulaziz  2 , Banan Abdullah Alsaif  2 , Amal Fahad Aljuhani  2 , Mohamed Abdalbary  3 , Eman Nagy  3 , Mostafa Abdelsalam  3
Affiliations
Multicenter Study

Incidence of bone fractures among patients on maintenance hemodialysis

Abdullah Kashgary et al. Ren Fail. 2023 Dec.

Abstract

Background: Patients with chronic kidney disease, especially those undergoing hemodialysis (HD), have a higher risk of fragility fractures. However, the magnitude of the problem and risk factors associated with fracture incidence have not been well studied in the Kingdom of Saudi Arabia.

Methods: This multicenter retrospective study involved HD centers in Jeddah from 2015 to 2021. This study included all adult HD patients. Patient demographics, medication usage, and clinical and biochemical parameters were collected from the registry records.

Results: The study included 328 patients on HD, with a mean age of 53 years. The median duration of HD was 47 months. Osteoporosis was found in 9% of the patients, and 8% had a previous parathyroidectomy. Over the observation period, fractures occurred in 32 patients, with an incidence rate of 20 case/1000 end stage kidney disease patients-year. Patients with fractures had a higher rate of osteoporosis, underwent more parathyroidectomy, had longer HD vintage, and higher bone-specific alkaline phosphatase (BSAP) levels. BSAP was the most significant predictor of fracture incidence in the regression analysis. Using a BSAP cutoff value of 96.6 µg/L, the sensitivity and specificity to predict fractures were 81.8% and 49%, respectively.

Conclusion: The main risk factors for incident fractures were osteoporosis, previous parathyroidectomy, longer HD vintage, and higher BSAP level. A higher BSAP score was the most significant predictor of incident fractures. This may highlight the importance of monitoring bone turnover markers and the negative impact of high bone turnover on patient health.

Keywords: Bone; CKD; bone-specific alkaline phosphatase; fractures; hemodialysis; kidney.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Figures

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