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01.07.2013 | Original Research | Ausgabe 1/2013

Calcified Tissue International 1/2013

High Prevalence of Vertebral Fractures Assessed by Quantitative Morphometry in Hemodialysis Patients, Strongly Associated with Vascular Calcifications

Calcified Tissue International > Ausgabe 1/2013
Maria Fusaro, Giovanni Tripepi, Marianna Noale, Nicola Vajente, Mario Plebani, Martina Zaninotto, Giuseppe Guglielmi, Diego Miotto, Luca Dalle Carbonare, Angela D’Angelo, Daniele Ciurlino, Riccarda Puggia, Davide Miozzo, Sandro Giannini, Maurizio Gallieni
Wichtige Hinweise
The study was conducted on behalf of EVERFRACT (Epidemiological VERtebral FRACtures iTalian Study in Dialysis) Study Investigators.
The members of the EVERFRACT (Epidemiological VERtebral FRACtures iTalian Study in Dialysis) Study Group are given in Appendix.
The authors have stated that they have no conflict of interest.


Few studies have provided information on the prevalence of vertebral fractures (VFs) and their risk factors in hemodialysis patients. A multicenter, cross-sectional, observational study was carried out to assess the prevalence of VFs and vascular calcifications (VCs) in 387 hemodialysis patients (mean age 64.2 ± 14.1 years, 63 % males) and in a control group of 51 osteoporotic subjects. Biochemical tests included 25(OH) vitamin D, bone Gla protein (total and undercarboxylated), and total matrix Gla protein. Vertebral quantitative morphometry was carried out centrally for the detection of VF, defined as reduction by ≥20 % of one of the vertebral body dimensions. In the same radiograph, aortic and iliac VC scores were calculated. Prevalence of VF was 55.3 % in hemodialysis patients and 51.0 % in the control group. Multivariate analysis disclosed that male gender (59.8 vs. 47.6 %, p = 0.02; OR = 1.78, 95 % CI 1.15–2.75) and age (mean ± SD 66.7 ± 13.1 vs. 61.0 ± 14.7 years, p < 0.001; OR = 1.03, 95 % CI 1.01–1.05) were significantly associated with VF. The prevalence of aortic VC was significantly higher in hemodialysis patients than in controls (80.6 vs. 68.4 %, p = 0.001). The factors with the strongest association with VC, apart from atrial fibrillation, were serum 25(OH)vitamin D levels below 29 ng/mL for aortic VC (OR = 1.85, 95 % CI 1.04–3.29) and VF both for aortic (OR = 1.77, 95 % CI 1.00–3.14) and iliac (OR = 1.96, 95 % CI 1.27–3.04) VC. In conclusion, the prevalence of VF, especially in males, and VC, in both genders, is high in hemodialysis patients. VF is associated with VC. Vitamin D deficiency is also associated with VC. Further longitudinal studies are warranted to investigate fractures in renal patients.

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