Factors associated with low bone mass in the hemodialysis patients--a cross-sectional correlation study.
BACKGROUND
Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients.


METHODS
Sixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD) assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass.


RESULTS
Using WHO criteria as a cutoff point, fifty-one subjects (81%) had a T-score lower than -1, of them 8 subjects (13%) had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP) level, and intact parathyroid hormone (iPTH) level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW) had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R(2) x 0.25), whereas BW and the ALP level significantly predicted the lumbar spine BMD (R(2) x 0.20).


CONCLUSIONS
This study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health in the patients undergoing hemodialysis.
Huang
Guey-Shiun
GS
Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan. gueysh@ntu.edu.tw
Chu
Tzong-Shinn
TS
Lou
Meei-Fang
MF
Hwang
Shiow-Li
SL
Yang
Rong-Sen
RS
D015502:Absorptiometry, Photon; D000328:Adult; D000367:Age Factors; D000368:Aged; D000469:Alkaline Phosphatase / Q000032:analysis / Q000097:blood; D001835:Body Weight / Q000502:physiology; D015519:Bone Density / Q000502:physiology*; D003430:Cross-Sectional Studies; D005081:Exercise Therapy / Q000592:standards; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000032:analysis / Q000097:blood; D010809:Physical Fitness / Q000502:physiology; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis
D010281:Parathyroid Hormone; D012709:Serum Albumin; D000469:Alkaline Phosphatase