Abstract
Fractures are a prevailing complication in dialysis patients. Although the association of age, female gender, diabetes, and malnutrition with fractures has been described, the significance of bone quality is unknown. Pentosidine and homocysteine appear to be useful biochemical markers of bone quality. Therefore, we studied the association of pentosidine, homocysteine, and other factors with the prevalence of fractures in hemodialysis patients. Serum pentosidine, homocysteine, albumin, creatinine, and whole PTH were determined before hemodialysis. The bone mineral density (BMD) of the lumbar spine (L1-L4, vertebrae with compression fractures were excluded), proximal femur, and distal 33% site of the radius was determined by dual-energy X-ray absorptiometry using DPX BRAVO (General Electric, Fairfield, CT, USA) and expressed in percentages of young adult means of both genders. The presence of vertebral and hip fractures was determined by history-taking and X-ray films. These data were collected from 81 patients on hemodialysis in our hospital. Vertebral and hip fractures were identified in 19 patients. Comparison between patients with and without fractures was performed using the Mann-Whitney U-test. Patients with fractures showed an older age (p=0.005), lower creatinine (p=0.011), lower whole PTH (p=0.020), lower lumbar BMD (p=0.025), lower hip BMD (p=0.001), and higher pentosidine (p=0.017). However, no significant differences were found in homocysteine, the body mass index, radius BMD, gender, DM, age, or albumin. Then, multivariable logistic regression analysis was performed with the prevalence of fractures as a dependent variable. In a stepwise model, pentosidine, creatinine, and hip BMD were chosen as independent variables. These results suggest that deterioration of the bone quality could be an independent risk of fractures in hemodialysis patients. Further studies are necessary to elucidate the association of high pentosidine with the incidence of fractures in uremic patients.
