title: High prevalence of vertebral fractures assessed by quantitative morphometry in hemodialysis patients, strongly associated with vascular calcifications.
abstract: Few studies have provided information on the prevalence of vertebral fractures (VFs) and their risk factors in hemodialysis patients. A multicenter, cross-sectional, observational study was carried out to assess the prevalence of VFs and vascular calcifications (VCs) in 387 hemodialysis patients (mean age 64.2 ± 14.1 years, 63 % males) and in a control group of 51 osteoporotic subjects. Biochemical tests included 25(OH) vitamin D, bone Gla protein (total and undercarboxylated), and total matrix Gla protein. Vertebral quantitative morphometry was carried out centrally for the detection of VF, defined as reduction by ≥20 % of one of the vertebral body dimensions. In the same radiograph, aortic and iliac VC scores were calculated. Prevalence of VF was 55.3 % in hemodialysis patients and 51.0 % in the control group. Multivariate analysis disclosed that male gender (59.8 vs. 47.6 %, p = 0.02; OR = 1.78, 95 % CI 1.15-2.75) and age (mean ± SD 66.7 ± 13.1 vs. 61.0 ± 14.7 years, p < 0.001; OR = 1.03, 95 % CI 1.01-1.05) were significantly associated with VF. The prevalence of aortic VC was significantly higher in hemodialysis patients than in controls (80.6 vs. 68.4 %, p = 0.001). The factors with the strongest association with VC, apart from atrial fibrillation, were serum 25(OH)vitamin D levels below 29 ng/mL for aortic VC (OR = 1.85, 95 % CI 1.04-3.29) and VF both for aortic (OR = 1.77, 95 % CI 1.00-3.14) and iliac (OR = 1.96, 95 % CI 1.27-3.04) VC. In conclusion, the prevalence of VF, especially in males, and VC, in both genders, is high in hemodialysis patients. VF is associated with VC. Vitamin D deficiency is also associated with VC. Further longitudinal studies are warranted to investigate fractures in renal patients.
authors.affiliation: Aging Section, Consiglio Nazionale delle Ricerche (CNR)-Institute of Neuroscience, Via Giustiniani, 2, 35128, Padua, Italy. dante.lucia@libero.it
authors.forename: Maria
authors.initials: M
authors.lastname: Fusaro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Marianna
authors.initials: M
authors.lastname: Noale
authors.forename: Nicola
authors.initials: N
authors.lastname: Vajente
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Martina
authors.initials: M
authors.lastname: Zaninotto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.forename: Luca
authors.initials: L
authors.lastname: Dalle Carbonare
authors.forename: Angela
authors.initials: A
authors.lastname: D'Angelo
authors.forename: Daniele
authors.initials: D
authors.lastname: Ciurlino
authors.forename: Riccarda
authors.initials: R
authors.lastname: Puggia
authors.forename: Davide
authors.initials: D
authors.lastname: Miozzo
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D016103:Spinal Fractures / Q000453:epidemiology* / Q000209:etiology; D061205:Vascular Calcification / Q000150:complications* / Q000473:pathology; D014807:Vitamin D / Q000097:blood
chemical_list: D014807:Vitamin D