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Low bone mineral density and fractures in stages 3-5 CKD: an updated systematic review and meta-analysis
R C Bucur1, D D Panjwani, L Turner
1Women's College Research Institute, 790 Bay Street, 7th Floor, Toronto, ON, M6G 1N8, Canada, roxana.roxana.bucur@wchospital.ca.
Insights
Bone mineral density (BMD) testing is useful for assessing fracture risk in chronic kidney disease (CKD). Lower BMD in CKD patients correlates with a higher incidence of fractures, regardless of dialysis status.
Area of Science:
- Nephrology
- Orthopedics
- Radiology
Background:
- Chronic kidney disease (CKD) is a known risk factor for fractures.
- The effectiveness of dual-energy X-ray absorptiometry (DXA) in predicting fracture risk among CKD patients remains unclear.
Purpose of the Study:
- To conduct a meta-analysis evaluating the association between BMD and fracture risk in patients with CKD.
- To determine the utility of DXA in assessing fracture risk in predialysis and dialysis CKD populations.
Main Methods:
- A systematic review and meta-analysis of studies reporting BMD and fracture data in CKD patients.
- Included 13 studies, primarily cross-sectional, examining DXA measurements and fracture status.
- Pooled results using a random-effects model, assessing heterogeneity with the I2 statistic.
Main Results:
- BMD was significantly lower in CKD patients with fractures compared to those without, across multiple skeletal sites (femoral neck, lumbar spine, radius).
- Observed differences in BMD were consistent in both predialysis and dialysis populations.
- Meta-analysis was limited by small study sizes and predominantly observational designs.
Conclusions:
- BMD measurements, assessed by DXA, can help discriminate fracture status in patients with CKD.
- Further large-scale, prospective studies are necessary to confirm these findings and refine clinical utility.
Summary:
The utility of bone mineral density (BMD) testing in chronic kidney disease (CKD) is not known. We performed a meta-analysis of studies reporting on BMD and fracture in CKD. All but one study was cross-sectional. BMD was lower in those with CKD and fractures compared to those without fractures.
Introduction:
CKD is associated with an increased risk of fracture. The utility of dual energy X-ray absorptiometry (DXA) to assess fracture risk in CKD is unknown.
Methods:
We performed an updated meta-analysis and systematic review of published studies that reported on the association between DXA and fracture (morphometric spine or clinical nonspine) in predialysis and dialysis CKD. We identified 2,894 potential publications, retrieved 292 for detailed review, and included 13. All but one study was cross-sectional and three reported on the ability of DXA to discriminate fracture status in predialysis CKD. Results were pooled using a random effects model and statistical heterogeneity was assessed using the I2 statistic.
Results:
BMD was statistically significantly lower at the femoral neck, lumbar spine, the 1/3 and ultradistal radius in subjects with fractures compared to those without regardless of dialysis status. For example, femoral neck BMD was 0.06 g/cm2 lower in dialysis subjects and 0.102 g/cm2 lower in predialysis subjects with fractures compared to those without. Lumbar spine BMD was 0.05 g/cm2 lower in dialysis subjects and 0.108 g/cm2 lower in predialysis subjects with fractures compared to those without. Our meta-analysis was limited to studies with small numbers of subjects and even smaller numbers of fractures. All of the studies were observational and only one was prospective. There was statistical heterogeneity at the lumbar spine, 1/3 and ultradistal radius.
Conclusions:
Our findings suggest that BMD can discriminate fracture status in predialysis and dialysis CKD. Larger, prospective studies are needed.
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