The Investigation Of Osteoporosis Prevalence And Risk Factors And The Prediction Of Fall And Fracture Risk In Maintenance Hemodialysis(MHD) Patients In A Single Center

Objective: To investigate the prevalence and the control rates of the mineral and bone disorder(MBD)and osteoporosis(OP) in maintenance hemodialysis(MHD) at the blood purification center of Nanchong central hospital, to analysis the reasons and risk factors of osteoporosis; To compute the fracture risk with the WHO fracture risk factor assessment tool(FRAX) and the Osteoporosis Self-assessment Tool(OSTA) and evaluate validity of the two tools in MHD patients. To evaluation validity of three functional mobility tests for predicting falls in MHD patients, comparative the fall risk between the MHD patients with the general population.Methods: We used the quantitative ultrasound bone mineral density measurement to measure the bone mineral density(BMD) of the patients in blood purification center of Nanchong central hospital from January 2013 to January 2014. We gathered the demographic information about the MHD patients, the clinical risk factors of OP and the CKD-MBD related indieators(such as serum calcium, phosphorus, serum intact parathyroid hormone(i PTH), alkaline phosphatase(ALP),hemoglobin,albumin,triglyceride, total cholesterol, creatinine, X-ray of lumbar and hip joint.).Then we separately compared the lab indexes in OP group and no-OP group and analysised the possible risk factors of OP by the Logistic regression analysis. To compute the fracture risk with FRAX and OSTA. According to the inclusion and exclusion criteria of fall in this research, 84 MHD patients were recruited and divided into two groups: fall group and no-fall group. All patients were tested by chair rising test(CRT),time up and go test(TUG) and tandem gait test( TGT),and record the test results.Results: 113 patients were fitted in this study;F/M=63/50, mean age=56.56±15.96 years, mean range of duration of hemodialysis= 26.88±26.87 months. The survey found that the morbidity of hyperphosphatemia, hypophosphatemia, hypercalcinemia, hypocalcemia, elevated PTH and reduced PTH were 67.26%, 3.54%, 16.81%, 39.82%, 71.68% and 5.31%. Only 5 patients achieved all the recommended standard levels of serum phosphorus, calcium and PTH, accounting for 4.42% of the whole population. The patients with ultrasound BMD measurement, the morbidity of bone mass normal, bone mass decreases and OP were 30.97%, 24.78% and 44.25%. On X-rays, the bone thinning or retrogression o f lumbar and hip joint were 41.84% and 30.61%. The proportion of patients meeting the eriteria of CKD-MBD was as high as 99.16%. To compared with the demographic information and biochemical laboratory indexes, it is found that OP was associated with age,gender, duration of CKD, dialysis age, dry weight, history of diabetes, ALB, PTH and ALP, and the results of the X-rays was also conformed with the two groups. 36 cases of 113 patients were conformed to the high risk of osteoporotic fracture diagnosis standard, the 10-year probability of a major osteoporotic fracture and hip fracture was(5.47 ±0.29)% and(2.60±0.33)%. In the test of OSTA, the high-risk, moderate risk and lower risk patients were 13.27%, 28.32% and 58.41%, respectively. To compared with FRAX and OSTA in the osteoporosis group and no-osteoporosis group found that, two types of assessment tools can effectively assess the risk of fracture in patients with MHD. The FRAX was negative correlation with BMD(r =-0.380--0.285, p < 0.01), the OSTA was positively correlation with BMD(r = 0.400, p < 0.001). 84 patients were took part in the trial of fall, the fall group has 23 patients(27.40%), who has fell in the process of dialysis, another group has 61 patients(73.60%).There were correlation of the age, CRT time, TUG time and TGT step number with history of falls(P<0.05).The BMI has no statistical significance with falling(P>0.05). The Logistic regression analysis revealed that the CRT,TUG and TGT were related to falling.Conclusion: The morbidity of CKD-MBD in the MHD Patients at our hemodialysis center is as high as 99.16%. The risk factors of OP are age, gender, duration of CKD, dialysis age, dry weight, history of diabetes, ALB, PTH and ALP. The CRT,TUG and TGT as an easily functional testing tool is useful for predicting falls in MHD patients.