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Osteoporotic Fractures in Men (MrOS) Study Group. Renal function and rate of hip bone loss in older men: the Osteoporotic Fractures in Men Study

Veterans Affairs Medical Center Geriatric Research Education and Clinical Center Minneapolis MN USA
Osteoporosis International (Impact Factor: 4.17). 11/2008; 19(11):1549-1556. DOI: 10.1007/s00198-008-0608-0

ABSTRACT SummaryOlder men with reduced renal function are at increased risk of hip bone loss. Given the robustness of this association across
different measures and a growing body of literature, our findings indicate that clinicians should take into account renal
function when evaluating older men for osteoporosis risk and bone loss. Future randomized controlled trials should test whether
interventions in this high risk population are effective in preventing bone loss and decreasing fracture incidence.

IntroductionStudies examining whether kidney impairment, not requiring dialysis, is associated with osteoporosis have reported conflicting
results.

MethodsWe tested the hypothesis that reduced renal function in older men as manifested by higher concentrations of cystatin C or
lower levels of estimated glomerular filtration rate (eGFR) is associated with higher rates of bone loss. We measured serum
cystatin C, serum creatinine and total hip bone mineral density (BMD) at baseline in a cohort of 404 older men enrolled in
the Osteoporotic Fractures in Men (MrOS) Study and followed them prospectively for an average of 4.4years for changes in
BMD. Associations between renal function and change in hip BMD were examined using linear regression.

ResultsIn multivariable analysis, the mean rate of decline in total hip BMD showed an increase in magnitude with higher cystatin
C concentration (mean annualized percent change −0.29, −0.34, −0.37 and −0.65% for quartiles 1 to 4; p for trend=0.004). Similarly,
adjusted rates of hip bone loss were higher among men with lower eGFR as defined by the modification of diet in renal disease
formula (mean annualized percent change −0.58, −0.39, −0.37, and −0.31 for quartiles 1 to 4; p for trend=0.02), but not among
men with lower eGFR as defined by the Cockcroft–Gault formula (mean annualized percent change −0.47, −0.44, −0.31 and −0.43
for quartiles 1 to 4; p for trend=0.48).

ConclusionsOlder men with reduced renal function are at increased risk of hip bone loss. Our findings suggest that health care providers
should consider renal function when evaluating older men for risk factors for bone loss and osteoporosis.

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    • "End-stage renal disease (ESRD) is a well-established risk factor for reduced bone mineral density (BMD) and osteoporosis as well as for hip fracture (1-3). Since the relationship between renal function and BMD in ESRD patients has been extensively investigated (4-7), it is suggested that an association between a moderate to severe decrease in glomerular filtration rate (GFR) in the absence of dialysis (K-DOQI [Kidney Disease Outcomes Quality Initiative] 3 and 4) and BMD (or osteoporosis) may exist among the general population (6, 7). Though the values of GFR and BMD vary across ethnicity, most previous studies of the potential association between renal function and BMD among the general population with stage 3 or 4 CKD have been performed in Western countries (6, 7). "
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    ABSTRACT: Recent studies in Western countries have reported a significant association between glomerular filtration rate (GFR) and bone mineral density (BMD) in the absence of dialysis among the general population. However, there have been few studies regarding renal function and BMD among Korean or Asian subjects with moderate to severe (stage 3 or 4) chronic kidney disease (MS-CKD). The aim of the present study was to investigate the association between MS-CKD and BMD in the general Korean population. BMD, serum creatinine and other measures were obtained from 3,190 subjects (1,428 males and 1,762 females; the fourth Korean National Health and Nutrition Examination Survey). GFR was estimated using the Cockcroft-Gault formula, with adjustment for body surface area. After adjustment for all variables, multiple regression analysis showed that BMD in the femur neck, total femur and lumbar spine were positively associated with eGFR in both males and females. Additional analysis showed that MS-CKD was also significantly associated with osteoporosis in both males and females (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.15-4.20 in males; and OR 1.96, 95% CI 1.33-2.88 in females). Individuals with MS-CKD may be at higher risk of osteoporosis even among Asians.
    Journal of Korean medical science 04/2013; 28(4):569-74. DOI:10.3346/jkms.2013.28.4.569 · 1.25 Impact Factor
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    • "Numerous investigations have revealed an association between ESRD risk and old age [2] [3] [11], men [2] [11] [38] [39], and comorbidities including hypertension [1–3,9–11], hyperlipidemia [1,2,9–11], PAD [9] [10], osteoporosis [12] [13] and asthma [13] [14] [15]. The risk of ESRD in the HFr and control cohorts with or without comorbidities differed (Table 2). "
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    ABSTRACT: Background: Inflammation-related microvasculr disease, albuminuria, and rapid deterioration of renal function can accelerate the development of end-stage renal disease (ESRD). The role of hip fracture (HFr), a disorder that involves inflammation, in the development of ESRD has not been fully investigated. This study explored whether HFr increases the risk of ESRD. Methods: Taiwan National Health Insurance inpatient claims were used to identify 83,550 patients newly diagnosed with HFr from 2000 to 2006, and 83,550 age- and sex-matched patients without HFr were randomly selected for comparison. Hazards of ESRD combined with HFr, comorbidities, including hypertension, hyperlipidemia, peripheral arterial disease, osteoporosis and asthma, and general health status, with Charlson comorbidity index (CCI), were assessed using data to the end of 2011. Results: ESRD risk was 1.42-fold higher (95% confidence interval [CI]:1.29–1.33) in the HFr cohort than in the control group, which was computed using the Cox proportional model. Age-specific analysis revealed that the adjusted hazard ratios (aHRs) of ESRD for HFr patients increased slightly as age increased, with an aHR of 1.56 (95% CI:1.35–1.81) for patients 65-74 years old, which gradually decreased to 0.88 (95% CI:0.66–1.18) for patients ≥85 years old. ESRD risk increased as HFr severity increased, with an aHR of 6.71 (95% CI:5.90–7.63) for patients with severe HFr. Conclusion: This study is the first to report that HFr, in combination with underlying osteoporosis-related chronic illness, microvascular disease and chronic inflammation, is associated with an increased risk of ESRD, particularly among relatively younger people.
    European Journal of Internal Medicine 09/2012; 25(10). DOI:10.1016/j.ejim.2014.10.017 · 2.30 Impact Factor
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