Bone density and heel ultrasound testing do not identify patients with dialysis-dependent renal failure who have had...

Patients with dialysis-dependent renal failure are at increased risk for low-trauma fractures. However, the optimal means of identifying patients at high risk for fracture is not known. We assessed the association between fracture history and two tests of bone mineral density (dual x-ray absorptiometry [DEXA] and calcaneal ultrasound) among patients with hemodialysis-dependent renal failure. We evaluated 71 men and 33 women aged 55 years or older who had been receiving hemodialysis for at least 1 year. All patients underwent spinal radiography, DEXA of the hip and lumbar spine, and calcaneal ultrasonography. We assessed risk factors for low-trauma fractures by questionnaire and medical chart review. Of patients, 52% had a fracture on spinal radiographs or a history of a low-trauma fracture, 69% had osteopenia by DEXA, and 26% had a low heel ultrasound measurement. Neither DEXA nor calcaneal ultrasound was associated with fracture history, however. Our findings indicate that fractures among patients with dialysis-dependent renal failure are common. Tests of bone strength do not adequately identify patients with a history of fractures. Prospective studies to determine the optimal method of identifying patients with dialysis-dependent renal failure at high risk for fracture are needed.