The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone
Summary The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hor...
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| Veröffentlicht in: | Osteoporosis international 2020-03, Vol.31 (3), p.515-524 |
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| creator | Jansz, T. T. Goto, N. A. van Ballegooijen, A. J. Willems, H. C. Verhaar, M. C. van Jaarsveld, B. C. |
| description | Summary
The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk.
Introduction
Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture.
Methods
In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture.
Results
Mean age of the study population was 52 ± 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13–55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (≥ 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders.
Conclusions
The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using |
| doi_str_mv | 10.1007/s00198-019-05187-0 |
| format | Article |
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The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk.
Introduction
Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture.
Methods
In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture.
Results
Mean age of the study population was 52 ± 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13–55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (≥ 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders.
Conclusions
The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using DXA and assessed vertebral fractures using lateral chest radiographs and not spine radiographs.</description><identifier>ISSN: 0937-941X</identifier><identifier>EISSN: 1433-2965</identifier><identifier>DOI: 10.1007/s00198-019-05187-0</identifier><identifier>PMID: 31728605</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Adult ; Aged ; Bone Density ; Bone mineral density ; Cancellous bone ; Chest ; Computed tomography ; Dialysis ; Dual energy X-ray absorptiometry ; End-stage renal disease ; Endocrinology ; Fractures ; Health risk assessment ; Hemodialysis ; Humans ; Incidence ; Kidney diseases ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - epidemiology ; Kidney transplantation ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original ; Original Article ; Orthopedics ; Osteoporosis ; Parathyroid ; Parathyroid Hormone ; Population studies ; Prevalence ; Quality of Life ; Radiography ; Rheumatology ; Spinal Fractures - diagnostic imaging ; Spinal Fractures - epidemiology ; Spinal Fractures - etiology ; Spine (lumbar) ; Transplants & implants ; Vertebrae</subject><ispartof>Osteoporosis international, 2020-03, Vol.31 (3), p.515-524</ispartof><rights>The Author(s) 2019</rights><rights>Osteoporosis International is a copyright of Springer, (2019). All Rights Reserved. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-5366cbd708a5200b351d85a45b37b1e599228684f887eb77f51c3347a535a5473</citedby><cites>FETCH-LOGICAL-c474t-5366cbd708a5200b351d85a45b37b1e599228684f887eb77f51c3347a535a5473</cites><orcidid>0000-0002-5686-5033</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00198-019-05187-0$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00198-019-05187-0$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31728605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jansz, T. T.</creatorcontrib><creatorcontrib>Goto, N. A.</creatorcontrib><creatorcontrib>van Ballegooijen, A. J.</creatorcontrib><creatorcontrib>Willems, H. C.</creatorcontrib><creatorcontrib>Verhaar, M. C.</creatorcontrib><creatorcontrib>van Jaarsveld, B. C.</creatorcontrib><title>The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone</title><title>Osteoporosis international</title><addtitle>Osteoporos Int</addtitle><addtitle>Osteoporos Int</addtitle><description>Summary
The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk.
Introduction
Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture.
Methods
In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture.
Results
Mean age of the study population was 52 ± 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13–55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (≥ 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders.
Conclusions
The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using DXA and assessed vertebral fractures using lateral chest radiographs and not spine radiographs.</description><subject>Adult</subject><subject>Aged</subject><subject>Bone Density</subject><subject>Bone mineral density</subject><subject>Cancellous bone</subject><subject>Chest</subject><subject>Computed tomography</subject><subject>Dialysis</subject><subject>Dual energy X-ray absorptiometry</subject><subject>End-stage renal disease</subject><subject>Endocrinology</subject><subject>Fractures</subject><subject>Health risk assessment</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - epidemiology</subject><subject>Kidney transplantation</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Osteoporosis</subject><subject>Parathyroid</subject><subject>Parathyroid Hormone</subject><subject>Population studies</subject><subject>Prevalence</subject><subject>Quality of Life</subject><subject>Radiography</subject><subject>Rheumatology</subject><subject>Spinal Fractures - diagnostic imaging</subject><subject>Spinal Fractures - epidemiology</subject><subject>Spinal Fractures - etiology</subject><subject>Spine (lumbar)</subject><subject>Transplants & implants</subject><subject>Vertebrae</subject><issn>0937-941X</issn><issn>1433-2965</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kUFP3DAQha2Kqmyhf4ADisSFi4sd27FzqVQhKJWQuFCJm-U4k92grL0dJyvx7_FuKNAeehnLmu-98fgRcsLZV86YvkiM8drQXChT3GjKPpAFl0LQsq7UAVmwWmhaS_5wSD6n9MiyqK71J3IouC5NxdSC4P0Kig3C1g0QPBQutEUffN_ub7ErtoAjNOiGokPnxwkhZaCA0NI0uiUUCCE32z6BS7N-zJYYh71849CNqyeMfVusIq5jgGPysXNDgi8v5xH5dX11f3lDb-9-_Lz8fku91HKkSlSVb1rNjFMlY41QvDXKSdUI3XBQdV3mHYzsjNHQaN0p7oWQ2imhnJJaHJFvs-9matbQeghjXsNusF87fLLR9fbvTuhXdhm3VjNdsYpng_MXA4y_J0ijXffJwzC4AHFKthRc7YIwLKNn_6CPccL8MTtK64pLLlSmypnyGFNC6F4fw5ndOdk5UpuL3Udqd9an79d4lfzJMANiBlJuhSXg2-z_2D4D5dis7A</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Jansz, T. T.</creator><creator>Goto, N. A.</creator><creator>van Ballegooijen, A. J.</creator><creator>Willems, H. C.</creator><creator>Verhaar, M. C.</creator><creator>van Jaarsveld, B. C.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5686-5033</orcidid></search><sort><creationdate>20200301</creationdate><title>The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone</title><author>Jansz, T. T. ; Goto, N. A. ; van Ballegooijen, A. J. ; Willems, H. C. ; Verhaar, M. C. ; van Jaarsveld, B. C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-5366cbd708a5200b351d85a45b37b1e599228684f887eb77f51c3347a535a5473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Bone Density</topic><topic>Bone mineral density</topic><topic>Cancellous bone</topic><topic>Chest</topic><topic>Computed tomography</topic><topic>Dialysis</topic><topic>Dual energy X-ray absorptiometry</topic><topic>End-stage renal disease</topic><topic>Endocrinology</topic><topic>Fractures</topic><topic>Health risk assessment</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kidney diseases</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Kidney Failure, Chronic - epidemiology</topic><topic>Kidney transplantation</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Osteoporosis</topic><topic>Parathyroid</topic><topic>Parathyroid Hormone</topic><topic>Population studies</topic><topic>Prevalence</topic><topic>Quality of Life</topic><topic>Radiography</topic><topic>Rheumatology</topic><topic>Spinal Fractures - diagnostic imaging</topic><topic>Spinal Fractures - epidemiology</topic><topic>Spinal Fractures - etiology</topic><topic>Spine (lumbar)</topic><topic>Transplants & implants</topic><topic>Vertebrae</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jansz, T. T.</creatorcontrib><creatorcontrib>Goto, N. A.</creatorcontrib><creatorcontrib>van Ballegooijen, A. J.</creatorcontrib><creatorcontrib>Willems, H. C.</creatorcontrib><creatorcontrib>Verhaar, M. C.</creatorcontrib><creatorcontrib>van Jaarsveld, B. C.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Osteoporosis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jansz, T. T.</au><au>Goto, N. A.</au><au>van Ballegooijen, A. J.</au><au>Willems, H. C.</au><au>Verhaar, M. C.</au><au>van Jaarsveld, B. C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone</atitle><jtitle>Osteoporosis international</jtitle><stitle>Osteoporos Int</stitle><addtitle>Osteoporos Int</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>31</volume><issue>3</issue><spage>515</spage><epage>524</epage><pages>515-524</pages><issn>0937-941X</issn><eissn>1433-2965</eissn><abstract>Summary
The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk.
Introduction
Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture.
Methods
In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture.
Results
Mean age of the study population was 52 ± 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13–55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (≥ 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders.
Conclusions
The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using DXA and assessed vertebral fractures using lateral chest radiographs and not spine radiographs.</abstract><cop>London</cop><pub>Springer London</pub><pmid>31728605</pmid><doi>10.1007/s00198-019-05187-0</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5686-5033</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Osteoporosis international, 2020-03, Vol.31 (3), p.515-524 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Bone Density Bone mineral density Cancellous bone Chest Computed tomography Dialysis Dual energy X-ray absorptiometry End-stage renal disease Endocrinology Fractures Health risk assessment Hemodialysis Humans Incidence Kidney diseases Kidney Failure, Chronic - complications Kidney Failure, Chronic - epidemiology Kidney transplantation Male Medicine Medicine & Public Health Middle Aged Original Original Article Orthopedics Osteoporosis Parathyroid Parathyroid Hormone Population studies Prevalence Quality of Life Radiography Rheumatology Spinal Fractures - diagnostic imaging Spinal Fractures - epidemiology Spinal Fractures - etiology Spine (lumbar) Transplants & implants Vertebrae |
| title | The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone |
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