title: Risk factors for diminished bone mineral density among male hemodialysis patients--a cross-sectional study.
abstract: This cross-sectional study was performed to characterize the factors affecting bone mass in male hemodialysis subjects. We found that of all the factors analyzed, the strongest correlation was with body mass index. In fact, after adjusting for body weight, the correlations with bone turnover markers and sex hormones were no longer significant.
  
  
  OBJECTIVE
  Abnormalities in bone and mineral metabolism are commonly seen in patients with end-stage renal disease, reducing bone quality and raising the risk of fracture. This cross-sectional study was performed to characterize risk factors affecting bone mass among male hemodialysis subjects.
  
  
  METHODS
  For this cross-sectional study, we recruited 66 men from three local hemodialysis units. Subjects received dual emission X-ray absorptiometry assessment of three sites (lumbar spine, hip, and distal radius) and the values were correlated with the levels of sex hormones, non-renally excreted bone turnover markers, and mineral metabolism markers.
  
  
  RESULTS
  Subjects were found to have bone mineral density (BMD) reduced predominantly at the distal radius, with Z score < −2 seen in 15.4 % and T score < −2.5 in 21 % of men. Independent predictors of bone density included levels of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b, which were inversely correlated with the femoral neck Z score. Factors positively associated with an increased Z score included body mass index at all sites and free estradiol levels at the hip and distal radius. Markers of mineral metabolism (e.g., calcium, phosphate, and 25-hydroxyvitamin D) were not correlated with Z scores of any site or with bone turnover markers. After adjusting for body weight, the associations between BMD, sex hormones, and bone turnover markers were no longer significant.
  
  
  CONCLUSIONS
  We recommend that future studies seeking to assess the factors affecting bone strength among male hemodialysis subjects incorporate a weight-adjusted analysis. Additionally, dialysis-dependent men receiving dual emission X-ray absorptiometry should have the distal radius site added to the standard assessment.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard Y5.322, Dallas, TX 75390-8857, USA.
authors.forename: Sasan
authors.initials: S
authors.lastname: Mirfakhraee
authors.forename: Khashayar
authors.initials: K
authors.lastname: Sakhaee
authors.forename: Joseph
authors.initials: J
authors.lastname: Zerwekh
authors.forename: Beverley
authors.initials: B
authors.lastname: Adams-Huet
authors.forename: Ugis
authors.initials: U
authors.lastname: Gruntmanis
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000378:metabolism; D003430:Cross-Sectional Studies; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000378:metabolism; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D012739:Gonadal Steroid Hormones