Risk factors for hip fracture in hemodialysis patients.
BACKGROUND
The incidence and mortality of hip fractures were several times greater in the patients with hemodialysis (HD) than in the general population. Although patients with end-stage renal disease develop renal osteodystrophy, few published data examined the risk factor of hip fractures in the dialysis population.


METHODS
The present study was performed to compare various indices and bone mineral density (BMD) of HD patients with or without the history of hip fractures. Moreover, we analyzed the factors which predicted hip fractures in 183 patients with chronic HD enrolled in the cross-sectional study.


RESULTS
Serum level of alkaline phosphatase was significantly higher in HD patients with hip fractures, compared to those without hip fractures. Oral calcium carbonate dose was significantly lower in HD patients with hip fractures. 1/3 radius (R)-BMD and ultradistal (UD)R-BMD were significantly lower in HD patients with hip fractures. However, lumbar spine (LS)-BMD was comparable in HD patients with or without hip fractures. Although there was no significant differences of BMD between with and without hip fractures in diabetes mellitus, UDR-BMD of patients with hip fractures was significantly lower than that of patients without hip fractures in chronic glomerulonephritis. Radial BMD was lower in female patients with hip fractures, compared to without hip fractures, although there were no significant differences in male patients. In multiple logistic regression analysis, oral calcitriol dose and 1/3R-BMD were selected as a risk factor of hip fractures in HD patients.


CONCLUSIONS
Radial BMD was lower in HD patients with hip fractures. However, its contribution is different, depending on gender and the original disease leading to HD. Radial BMD and oral calcitriol dose seemed to be important to predict the risk of hip fractures.
Kaji
Hiroshi
H
Hattori Hospital, Miki, Neurology and Hematology/Oncology, Department of Clinical Medicine, Kobe Graduate University School of Medicine, Japan. hiroshik@med.kobe-u.ac.jp
Suzuki
Mizune
M
Yano
Shozo
S
Sugimoto
Toshitsugu
T
Chihara
Kazuo
K
Hattori
Saburo
S
Sekita
Kenichi
K
D000284:Administration, Oral; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D015519:Bone Density / Q000187:drug effects; D002117:Calcitriol / Q000008:administration & dosage; D002120:Calcium Channel Agonists / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D006620:Hip Fractures / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric
D015415:Biomarkers; D002120:Calcium Channel Agonists; D002117:Calcitriol