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

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Abstract

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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Acknowledgments

The authors thank Jennifer Hartwig, MD, medical writer, for manuscript editing. The study was funded by the Consiglio Nazionale delle Ricerche (CNR), Aging Section, Institute of Neuroscience, Padua, Italy. The authors also state that they have full control of all primary data and that they agree to allow the journal to review their data if requested.

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Authors and Affiliations

  1. Aging Section, Consiglio Nazionale delle Ricerche (CNR)—Institute of Neuroscience, Via Giustiniani, 2, 35128, Padua, Italy

    Maria Fusaro & Marianna Noale

  2. Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR-Istituto di Biometeorologia, Reggio Calabria, Italy

    Giovanni Tripepi

  3. Dipartimento di Medicina di Laboratorio, University Hospital of Padua, Padua, Italy

    Nicola Vajente, Mario Plebani & Martina Zaninotto

  4. Department of Radiology, University of Foggia, Foggia, Italy

    Giuseppe Guglielmi

  5. Department of Radiology, Scientific Institute Hospital “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

    Giuseppe Guglielmi

  6. Dipartimento di Medicina, Sezione di Radiologia, University of Padua, Padua, Italy

    Diego Miotto

  7. Department of Medicine, Medicina Interna D, University of Verona, Verona, Italy

    Luca Dalle Carbonare

  8. Nephrology Unit, University of Padua, Padua, Italy

    Angela D’Angelo & Davide Miozzo

  9. Renal Unit, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy

    Daniele Ciurlino

  10. Nephrology and Dialysis Unit, Ospedale S. Maria di Ca’ Foncello, Treviso, Italy

    Riccarda Puggia

  11. Department of Clinical and Experimental Medicine, Medical Clinic 4, University of Padua, Padua, Italy

    Sandro Giannini

  12. Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, Milan, Italy

    Maurizio Gallieni

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  1. Maria Fusaro
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  2. Giovanni Tripepi
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  7. Giuseppe Guglielmi
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  8. Diego Miotto
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  15. Maurizio Gallieni
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Corresponding author

Correspondence to Maria Fusaro.

Additional information

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.

Appendix: The EVERFRACT (Epidemiological VERtebral FRACtures iTalian Study in Dialysis) Study Group

Appendix: The EVERFRACT (Epidemiological VERtebral FRACtures iTalian Study in Dialysis) Study Group

The EVERFRACT (Epidemiological VERtebral FRACtures iTalian Study in Dialysis) Study Group included the following nephrologists from 18 dialysis centers, who participated in selecting patients and providing clinical data collection, listed according to the number of patients entered into the study: Nephrology and Dialysis Unit, University of Padua: D. Miozzo, A. Naso, M. Rebeschini, M. C. Tineo, M. T. Vilei; Nephrology and Dialysis Unit, Ospedale Nuovo San Giovanni di Dio, Florence: C. Grimaldi, A. Mannarino; Nephrology and Dialysis Unit, IRCCS Multimedica, Sesto San Giovanni, Milan: S. Bertoli, D. Ciurlino; Nephrology, Dialysis and Transplant Unit, Ospedale S. Maria Dei Battuti, Treviso: R. Puggia, A. Caberlotto, S. Mastrosimone, C. Cascone; Nephrology and Dialysis Unit, Azienda Sanitaria di Bolzano: R. Corradini, M. Avolio, B. Giacon; Nephrology and Dialysis Unit, Ospedale Civile di Voghera, Pavia: A. Foschi, C. Barbieri, F. Milanesi; Nephrology and Dialysis Unit, Ospedale di Trento, Trento: A. Pica, C. Venturelli, G. Brunori; Nephrology and Dialysis Unit, Ospedale S. Maria della Misericordia, Rovigo: T. Pati, A. Gemelli, F. Fiorini; Nephrology and Dialysis Unit, Azienda Ospedaliera di Lodi, Lodi: F. Barbisoni, M. Farina; Nephrology and Dialysis Unit, Ospedale Umberto I, Mestre-Venice: P. Morachiello, M. Feriani; Hemodialysis Unit, Adria, Rovigo: F. Stoppa; Nephrology and Dialysis Unit, Ospedale Civile, Belluno: G. Tarroni, E. De Paoli Vitali; Nephrology and Dialysis Unit, Ospedale Civile di Dolo, Venice: S. Lucatello, G. Meneghel; Nephrology and Dialysis Unit, Ospedale S. Maria del Prato, Feltre, Belluno: A. Vianello, F. Antonucci; Nephrology and Dialysis Unit, Ospedale S. Bassiano, Bassano del Grappa, Vicenza: V. Pellanda, R. Dell’Aquila; Nephrology and Dialysis Unit, Ospedale S. Giacomo, Castelfranco Veneto, Padua: A. Ferraro, C. Abaterusso; Nephrology and Dialysis Unit, Ospedale S. Camillo De Lellis, Schio, Vicenza: F. M. Magonara, M. Axia; Nephrology and Dialysis Unit, Ospedale di Chioggia, Venice: M. Spinello, M. Urso.

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Fusaro, M., Tripepi, G., Noale, M. et al. High Prevalence of Vertebral Fractures Assessed by Quantitative Morphometry in Hemodialysis Patients, Strongly Associated with Vascular Calcifications. Calcif Tissue Int 93, 39–47 (2013). https://doi.org/10.1007/s00223-013-9722-x

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