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Abstract: TH-PO131

Lower Parathyroid Hormone Levels Are Associated with Lower Risk of Fractures in Japanese Hemodialysis Patients: A Nationwide Cohort Study

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical


  • Komaba, Hirotaka, Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Imaizumi, Takahiro, Nagoya University Hospital, Nagoya, Japan
  • Hamano, Takayuki, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  • Fujii, Naohiko, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
  • Abe, Masanori, Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Hanafusa, Norio, Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Japan

Secondary hyperparathyroidism is associated with high-turnover bone disease in hemodialysis patients. However, conflicting evidence exists as to whether parathyroid hormone (PTH) levels are associated with fracture risk and whether the relationship is linear or U-shaped.


Using data from the Japanese Society for Dialysis Therapy Renal Data Registry, we analyzed 180,333 adult hemodialysis patients with data on serum albumin, calcium, phosphorus, and intact or whole PTH at the end of 2016 and data on hospitalization in 2017. The primary outcome was the composite of hospitalizations due to hip, vertebral, and other fractures. The secondary outcomes included hospitalization due to site-specific fracture. Fracture risk was assessed using Cox proportional hazards models, adjusted for potential confounders. We also examined the association between percent change in PTH levels during a 1-year baseline period and subsequent risk of fractures.


At baseline, the median intact PTH level was 141 pg/mL (interquartile range, 78–226 pg/mL). During the 1-year follow-up, there were a total of 3,762 fractures requiring hospitalization (1,361 hip, 551 vertebral, and 1,850 others). In adjusted analyses, increasing PTH levels were associated with a monotonically increasing risk of fractures (odds ratio per doubling of intact PTH, 1.06; 95% CI, 1.03–1.09). When analyzed in deciles, the risk of fracture was lowest in the lowest decile of intact PTH levels (<39 pg/mL). The relationship between PTH levels and fracture risk was more pronounced for hip fractures, whereas there was no association between PTH levels and vertebral fractures. Changes in PTH levels were also associated with fracture risk: the adjusted odds ratio of fractures per 30% reduction in PTH during a 1-year baseline period was 0.97 (95% CI, 0.95–0.99).


Lower PTH levels are associated with a monotonically decreasing risk of fractures. Further studies are needed to determine whether intensive control of PTH decreases fracture risk.