Association between bone mineral density at different anatomical sites and both mortality and fracture risk in patients receiving renal replacement therapy: a longitudinal study

Abstract Background The clinical utility of bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) is debated in end-stage kidney disease (ESKD). We assessed the ability of BMD measured at different anatomical sites to predict mortality and fracture risk in patients requiring renal replacement therapy (RRT). Methods We reviewed all-cause mortality as well as incident hip and overall fracture risk in RRT patients who had BMD measured at the femoral neck, lumbar spine, arm, head, pelvis and total body as part of their routine follow-up between January 2004 and June 2012 at a single university centre. Results A total of 588 patients were included. The median follow-up was 6.5 years, the mean age was 59.6 years and 57.9% were males. Femoral neck BMD (FNBMD) (normal/high versus low) was negatively associated with mortality in univariate and multivariate analyses (P