ECTS2013 Poster Presentations Osteoporosis: pathophysiology and epidemiology (49 abstracts)
Estimated glomerular filtration rate is associated with bone fragility in the elderly
Maria João Gonçalves 1 , Ana Rodrigues 1 , Joana Caetano-Lopes 1 , Emilia Raquel 1 , Ana Lopes 1 , Bruno Vidal 1 , Ana Catarina Vale 3 , Marco Sarmento 2 , Maria Fátima Vaz 3 , Jacinto Monteiro 2 , João Eurico Fonseca 1 & Helena Canhão 1
1Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal; 2Orthopaedics Department, Santa Maria Hospital, Lisbon, Portugal; 3Mechanics Engineering Department, Instituto Superior Técnico, Lisbon, Portugal.
Introduction: Osteoporosis is frequently associated with renal disease, namely the bone metabolism disturbances caused by secondary hyperparathyroidism of chronic kidney disease (CKD). The increased risk of fragility fractures is well demonstrated in patients with end-stage renal disease (ESRD). There is recent evidence that bone pathological changes start early in the course of CKD. Our aim is to evaluate whether chronic renal disease, before ESRD, is associated with bone fragility. Bone fragility was assessed considering history of fragility fracture events, 10-year risk for major osteoporotic fractures and hip fractures (FRAX), biochemical bone turnover markers (P1NP and CTX) and mechanical testing to determine bone stiffness.
Design: We studied patients admitted for total hip replacement surgery. They were asked for clinical data and blood samples. Blood biomechanical studies were performed and a bone cylinder was drilled from their femoral epiphyses. Glomerular filtration rate (GFR) was estimated using Cockcroft-Gault formula; we excluded patients with obvious limitations to the application of the formula. We also excluded from the analysis patients with terminal renal impairment, with eGFR ≤15 ml/min or history of renal replacement therapy.
Results: We included 111 patients. Mean age 74.31±10.03, 70% of subjects were female, 98% Caucasian. Fragility fracture had an inverted relation with eGFR (P=0.023). The clinical score FRAX was inverted related with eGFR (for both risks P=≤0.0001). The biomarker CTX also showed an inverted relation with eGFR (P=0.003). P1NP (P=0.056) and bone stiffness (coefficient 2.42, P=0.073) showed a trend for association with eGFR. All analysis were adjusted for age and gender.
Conclusion: Renal impairment in early stages, measured by eGFR, was associated with increased bone fragility assessed by fracture events, FRAX and bone turnover and biomechanics biomarkers, after adjustment to age and sex.
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