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Kidney Week

Abstract: PO0401

Ethnic Differences in the Association of Kidney Function and Low Bone Density

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Chang, Joshua, Kaiser Permanente Oakland Medical Center, Oakland, California, United States
  • Chandra, Malini, Kaiser Permanente Oakland Medical Center, Oakland, California, United States
  • Darbinian, Jeanne A., Kaiser Permanente Oakland Medical Center, Oakland, California, United States
  • Ramalingam, Nirmala D., Kaiser Permanente Oakland Medical Center, Oakland, California, United States
  • Lo, Joan C., Kaiser Permanente Oakland Medical Center, Oakland, California, United States
  • Zheng, Sijie, Kaiser Permanente Oakland Medical Center, Oakland, California, United States
Background

Chronic kidney disease (CKD) is an important risk factor for bone disease and fracture. Here, we examined the relationship between reduced kidney function (RKF) and bone mineral density (BMD) in women. We also examined PTH and calcium levels among a subset of patients with advanced CKD and low BMD (osteoporosis range).

Methods

We examined femoral neck BMD in 118,484 women age 60-79 with an ambulatory creatinine/eGFR within 1 year of the BMD scan and compared the proportion with low BMD (T-score ≤ -2.5) by kidney function. Presence of hyperparathyroidism (PTH > 65 and > 130 pg/mL) and hypercalcemia (Ca ≥ 10.5 mg/dL) was examined in a subset of 257 patients with low BMD and advanced CKD G3B (eGFR < 45) and G4/G5 (eGFR < 30) who had PTH, calcium, and confirmatory eGFR measured within 2 years of BMD scan.

Results

Among 118,484 women, 83% had eGFR ≥ 60, 12% had eGFR 59-45, 4% had eGFR 44-30, and 1% had eGFR < 30. Overall, 12% of women age 60-69 and 21% of women age 70-79 had low BMD, but this varied by race/ethnicity. Asians had the highest burden of low BMD. Within each race/ethnicity group, the burden of low BMD varied by RKF/eGFR (Figure). In the subset with low BMD, advanced CKD, and measured PTH and calcium, 9.7% of G3B (n = 145) and 5.4% of G4/G5 (n = 112) patients were hypercalcemic. Of these hypercalcemic patients, 57% with G3B had PTH > 65 pg/mL (28.6% had PTH > 130 pg/mL), and all with CKD G4/G5 (n = 6) had PTH > 65 pg/mL (n = 4 > 130 pg/mL). Of the remainder with normal/low calcium, 57% with G3B and 84% with G4/G5 had PTH > 65 pg/mL (19% of G3B and 53% of G4/G5 had PTH > 130 pg/mL).

Conclusion

The burden of low BMD and the association of RKF with low BMD varied by race/ethnicity. The majority of patients with advanced CKD and low BMD also had evidence of hyperparathyroidism when laboratory data were assessed. Our findings support guidelines for PTH and BMD screening in advanced CKD patients to optimize bone health.

Low BMD and RKF by Race/Ethnicity

Funding

  • Private Foundation Support