title: Low bone mineral density and fractures in stages 3-5 CKD: an updated systematic review and meta-analysis.
abstract: CONCLUSIONS
  The utility of bone mineral density (BMD) testing in chronic kidney disease (CKD) is not known. We performed a meta-analysis of studies reporting on BMD and fracture in CKD. All but one study was cross-sectional. BMD was lower in those with CKD and fractures compared to those without fractures.
  
  
  BACKGROUND
  CKD is associated with an increased risk of fracture. The utility of dual energy X-ray absorptiometry (DXA) to assess fracture risk in CKD is unknown.
  
  
  METHODS
  We performed an updated meta-analysis and systematic review of published studies that reported on the association between DXA and fracture (morphometric spine or clinical nonspine) in predialysis and dialysis CKD. We identified 2,894 potential publications, retrieved 292 for detailed review, and included 13. All but one study was cross-sectional and three reported on the ability of DXA to discriminate fracture status in predialysis CKD. Results were pooled using a random effects model and statistical heterogeneity was assessed using the I2 statistic.
  
  
  RESULTS
  BMD was statistically significantly lower at the femoral neck, lumbar spine, the 1/3 and ultradistal radius in subjects with fractures compared to those without regardless of dialysis status. For example, femoral neck BMD was 0.06 g/cm2 lower in dialysis subjects and 0.102 g/cm2 lower in predialysis subjects with fractures compared to those without. Lumbar spine BMD was 0.05 g/cm2 lower in dialysis subjects and 0.108 g/cm2 lower in predialysis subjects with fractures compared to those without. Our meta-analysis was limited to studies with small numbers of subjects and even smaller numbers of fractures. All of the studies were observational and only one was prospective. There was statistical heterogeneity at the lumbar spine, 1/3 and ultradistal radius.
  
  
  CONCLUSIONS
  Our findings suggest that BMD can discriminate fracture status in predialysis and dialysis CKD. Larger, prospective studies are needed.
authors.affiliation: Women's College Research Institute, 790 Bay Street, 7th Floor, Toronto, ON, M6G 1N8, Canada, roxana.roxana.bucur@wchospital.ca.
authors.forename: R C
authors.initials: RC
authors.lastname: Bucur
authors.forename: D D
authors.initials: DD
authors.lastname: Panjwani
authors.forename: L
authors.initials: L
authors.lastname: Turner
authors.forename: T
authors.initials: T
authors.lastname: Rader
authors.forename: S L
authors.initials: SL
authors.lastname: West
authors.forename: S A
authors.initials: SA
authors.lastname: Jamal
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors