Renal function and rate of hip bone loss in older men: the Osteoporotic Fractures in Men Study
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
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.
Clinical Journal of the American Society of Nephrology 06/2014; 9(7). DOI:10.2215/CJN.04660514 · 5.25 Impact Factor
Article: Current Status of Bicarbonate in CKD[Show abstract] [Hide abstract]
ABSTRACT: Metabolic acidosis was one of the earliest complications to be recognized and explained pathologically in patients with CKD. Despite the accumulated evidence of deleterious effects of acidosis, treatment of acidosis has been tested very little, especially with respect to standard clinical outcomes. On the basis of fundamental research and small alkali supplementation trials, correcting metabolic acidosis has a strikingly broad array of potential benefits. This review summarizes the published evidence on the association between serum bicarbonate and clinical outcomes. We discuss the role of alkali supplementation in CKD as it relates to retarding kidney disease progression, improving metabolic and musculoskeletal complications.Journal of the American Society of Nephrology 08/2014; 26(3). DOI:10.1681/ASN.2014020205 · 9.47 Impact Factor