CKD: secondary hyperparathyroidism tied to low BMD

  • Bezerra de Carvalho KS & al.
  • Osteoporos Int
  • 28 Jan 2019

  • International Clinical Digest
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Takeaway

  • Secondary hyperparathyroidism (SHPT) is associated with low bone mineral density (BMD) among patients with chronic kidney disease (CKD), the hip being the most affected site.

Why this matters

  • Hip involvement may reflect greater impairment of cortical vs trabecular bone.
  • Findings may shed light on higher rate of hip vs spine fracture in CKD.

Study design

  • Review of dual-energy X-ray absorptiometry and biochemical data from 1172 patients with CKD (81.3% female, 79.9% white, 8.1% with diabetes).
  • Mean estimated glomerular filtration rate (eGFR, in mL/minute/1.73 m2), 73±35.
  • Funding: Conselho Nacional de Desenvolvimento Científico e Tecnológico.   

Key results

  • 32.7% had osteopenia, and 20.0% had ≥1 osteoporotic site.
  • Prevalence of osteopenia and osteoporosis increased with CKD stage.
  • Stage ≥3 CKD was associated with greater likelihood of hip involvement.
  • No significant association between CKD stage and BMD at the spine (P=.871).
  • Hip osteopenia/osteoporosis was predicted by SHPT (levels ≥65 pg/mL; relative risk [RR]=1.954; P=.0001) and older age (per year, RR=1.043; P=.0001).
  • Compared with eGFR ≥90, odds of osteopenia/osteoporosis was:
    • 51% higher with eGFR of 30-60 (OR, 1.51; 95% CI, 1.01-2.24).
    • 91% higher with eGFR of 15-30 (OR, 1.91; 95% CI, 1.13-3.20).

Limitations

  • Observational, single-center study.

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