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.
- SourceAvailable from: Teresa Adragao
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ABSTRACT: There is increasing evidence that altered bone metabolism is associated with cardiovascular calcifications in patients with stage 5 chronic kidney disease on hemodialysis (HD). This study was conducted to evaluate the association between bone volume, turnover, and coronary calcifications in HD patients. In a cross-sectional study, bone biopsies and multislice computed tomography were performed in 38 HD patients. Bone volume/total volume, activation frequency, and bone formation rate/bone surface were determined by histomorphometry and coronary calcifications were quantified by Agatston scores. Prevalence of low bone turnover was 50% and of low bone volume was 16%. Among the studied traditional cardiovascular risk factors, only age was found to be associated with coronary calcifications. Lower bone volume was a significant risk factor for coronary calcifications during early years of HD, whereas this effect was not observed in patients with dialysis duration >6 yr. Histomorphometric parameters of bone turnover were not associated with coronary calcifications. Low bone volume is associated with increased coronary calcifications in patients on HD.Clinical Journal of the American Society of Nephrology 02/2009; 4(2):450-5. DOI:10.2215/CJN.01870408 · 5.25 Impact Factor
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ABSTRACT: Previous studies in older men have not evaluated whether loss of BMD or BMC accelerates nonlinearly with age. This study aimed to describe hip bone loss (both in BMC and BMD) in older men and to test whether BMD loss accelerates with age in an exponential manner in a cohort of 4720 community-dwelling men >or=65 yr of age. Men had two to three measures of femoral neck (FN) BMD (by DXA) over an average follow-up of 4.6 yr. Change in BMD during follow-up was estimated from mixed effects regression models; the significance of a quadratic term for age was evaluated. Mean FN BMD loss was 0.013 g/cm(2) (-1.72%) during follow-up. The quadratic term for age was significant, and the model showed that bone loss accelerated with age. Estimated loss of FN BMD over follow-up for men 85 yr of age (0.021 g/cm(2)) was 2.5 times greater than the loss expected for men 65 yr of age (0.008 g/cm(2)); such bone loss in 85-yr-old men may be sufficient to increase the risk of hip fracture by 25% (HR per 0.021 g/cm(2) cross-sectional decrease in FN BMD: 1.25; 95% CI: 1.18-1.31) over 4.6 yr. Men with lower BMD at baseline lost the most BMD over follow-up. Although average bone loss over time is modest in older men, there is considerable variability in rate of loss. Older men and those with lower BMD lose bone more rapidly, offering potential explanation for the increasing risk of fracture with advancing age.Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2009; 24(10):1728-35. DOI:10.1359/jbmr.090419 · 6.59 Impact Factor