title: Discriminants of prevalent fractures in chronic kidney disease.
abstract: Patients with chronic kidney disease (CKD) have higher rates of fracture than the general population. Increased bone remodeling, leading to microarchitectural deterioration and increased fragility, may accompany declining kidney function, but there are no reliable methods to identify patients at increased risk for fracture. In this cross-sectional study of 82 patients with predialysis CKD, high-resolution imaging revealed that the 23 patients with current fractures had significantly lower areal density at the femoral neck; total, cortical, and trabecular volumetric bone density; cortical area and thickness; and trabecular thickness. Compared with levels in the lowest tertile, higher levels of osteocalcin, procollagen type-1 N-terminal propeptide, and tartrate-resistant acid phosphatase 5b were associated with higher odds of fracture, even after adjustment for femoral neck T-score. Discrimination of fracture prevalence was best with a femoral neck T-score of -2.0 or less and a value in the upper two tertiles for osteocalcin, procollagen type-1 N-terminal propeptide, or tartrate-resistant acid phosphatase 5b; these values corresponded to the upper half of the normal premenopausal reference range. In summary, these cross-sectional data suggest that measurement of bone turnover markers may increase the diagnostic accuracy of densitometry to identify patients with CKD at high risk for fracture.
authors.affiliation: Department of Medicine, Divisions of Nephrology, Columbia University Medical Center, New York, New York, USA. tln2001@columbia.edu
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Nickolas
authors.forename: Serge
authors.initials: S
authors.lastname: Cremers
authors.forename: Amy
authors.initials: A
authors.lastname: Zhang
authors.forename: Valeri
authors.initials: V
authors.lastname: Thomas
authors.forename: Emily
authors.initials: E
authors.lastname: Stein
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.forename: Ryan
authors.initials: R
authors.lastname: Chauncey
authors.forename: Lucas
authors.initials: L
authors.lastname: Nikkel
authors.forename: Michael T
authors.initials: MT
authors.lastname: Yin
authors.forename: Xiaowei S
authors.initials: XS
authors.lastname: Liu
authors.forename: Stephanie
authors.initials: S
authors.lastname: Boutroy
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Staron
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Dworakowski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000473:pathology; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015675:Osteocalcin / Q000378:metabolism; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D015675:Osteocalcin