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Abstract: SA-PO165

Fracture, Vascular Calcification, and Bone Turnover: The Important Interrelationship in Disorder of Bone and Mineral Metabolism in CKD

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Gueiros, Ana Paula, Universidade Federal de Pernambuco, Recife, PE, Brazil
  • Coutinho, Luiz Alberto soares de araújo, Universidade Federal de Pernambuco, Recife, PE, Brazil
  • Vaz, Julia Braga, Universidade Federal de Pernambuco, Recife, PE, Brazil
  • Russo, Eduarda Cerqueira, Universidade Federal de Pernambuco, Recife, PE, Brazil
  • Jorgetti, Vanda, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Gueiros, Jose Edevanilson, Universidade Federal de Pernambuco, Recife, PE, Brazil
Background

Disorders in bone and mineral metabolism are ubiquitous in hemodialysis (HD) patients. The aim of this study was to assess factors associated with the occurrence of fracture in HD patients undergoing bone biopsy (BB).

Methods

The medical records of 250 patients were reviewed. Clinical data: age, sex, time on HD and fracture. Laboratory: Calcium, phosphorus (P), intact parathyroid hormone (iPTH), total alkaline phosphatase. Vascular calcification (VC) was assessed by x-rays. A qualitative analysis of BB considered the diagnoses: osteitis fibrosa (OF), mixed disease (MD), adynamic bone disease (ABD), osteomalacia (OM) and osteoporosis (OP). A comparative analysis was performed between patients with and without fracture. Univariate and multivariate analyses verified the predictors of fracture and OP.

Results

Median age of patients: 48 years; 57.6% were women and the median time on HD was 9 years. The prevalence of fracture, OP and VC were 8.3%, 43.6% and 45.5%, respectively. In relation to BB, 54.4% of patients presented OF, 30% MD, 12.4% ABD and 3.2% OM. Patients with and without fracture (F x NF) were distinguished by the presence of VC (75% x 41.9%; p=0.01), OP (68.4% x 40.9%; p=0.02), a diagnosis of ABD (31.5% x 10% ; p=0.01), bone turnover (High/Low) (63.1% x 87.6%/36.8% x 12.3%; p=0.01) and by P (mg/dL) (4.6 x 5.9; p=0.003); and a tendency towards iPTH (pg/mL) (415 x 1190; p=0.05). Univariate analysis for risk of fracture: VC (OR 4.15, 95% CI 1.39-15.3; p=0.01), OP (OR 3.12, CI 1.19-9.19; p=0.02), bone turnover (Low OR 4.13, CI 1.43-11.3; p=0.006) and P (OR 0.67, CI 0.49-0.89; p=0.007). In the multivariate model, VC (OR 3.73, CI 1.21-14; p=0.03) and P (OR 0.75, CI 0.53-1.02; p=0.007) remained. Univariate analysis for OP risk: age (OR 1.02, CI 1.00-1.04; p=0.02), fracture (OR 3.12, CI 1.19-9.19; p=0.02), P (OR 0.85, CI 0.73-0.97; p =0.02) and a diagnosis of OF (OR 0.54, CI 0.33-0.90; p=0.01). In the multivariate model, only fracture remained (OR 3.03, CI 1.06-10; p=0.04).

Conclusion

1. There was a high prevalence of OP and VC in HD patients. 2. We have confirmed the important interrelationship of bone metabolism with the vessel. 3. We have demonstrated the association of low bone turnover with fracture.