title: Forearm bone mass predicts mortality in chronic hemodialysis patients.
abstract: We aim to determine the relationship between bone mineral density (BMD), measured by T- and Z-score, and mortality risk in hemodialysis (HD) patients. We also investigate which are the most suitable skeletal sites for predicting mortality rate. We analyzed the survival of 102 patients who had been treated with chronic HD according to BMD. Patients with a T-score ≤2.5 at the middle, ultradistal and proximal part of the forearm had a higher mortality risk than those with a T-score of -2.5 or higher. Furthermore, no statistically significant association was found between loss of bone mass at other measuring points-lumbar spine (anteroposterior orientation from L1-L4) and hip (neck, trochanter, intertrochanter, total and Ward's triangle)-and mortality risk. We were also interested in exploring the relationship between Z-score at different skeletal regions and mortality risk. We found that patients with a Z-score of -1 or lower at all three parts of the forearm had a greater mortality risk. It is also worth noting that the Z-score at all three parts of the forearm was a more apparent predictor of mortality, compared to the T-score at the same skeletal regions. This empirical analysis showed that BMD assessments should be obtained at the forearm, due to the good predictability of this skeletal site regarding mortality of HD patients. Moreover, data concerning bone density should be reported as Z-scores.
authors.affiliation: Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Tome Strižića 3, Rijeka, Croatia. lidija.orlic@gmail.com.
authors.forename: Lidija
authors.initials: L
authors.lastname: Orlic
authors.affiliation: Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Tome Strižića 3, Rijeka, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Mikolasevic
authors.affiliation: Department of Endocrinology, University Hospital Center Rijeka, Rijeka, Croatia.
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Crncevic-Orlic
authors.affiliation: School of Medicine, Rijeka, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Jakopcic
authors.affiliation: Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
authors.forename: Josipa
authors.initials: J
authors.lastname: Josipovic
authors.affiliation: Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
authors.forename: Drasko
authors.initials: D
authors.lastname: Pavlovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology*; D002423:Cause of Death; D003710:Demography; D005260:Female; D005542:Forearm / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors
keywords: Bone mineral density; Chronic hemodialysis; Forearm; Mortality; Survival; Z-scores