1. INTRODUCTIONS and AIM METHODS REFERENCES: CONCLUSIONS
VERTEBRAL FRACTURES IN DIALYSIS PATIENTS: A CLINICALLY RELEVANT PROBLEM WITH INSUFFICIENT INVESTIGATION
(Epidemiological VERtebral FRACtures iTalian Study in Dialysis Patients:
EVERFRACT Study)
M. Fusaro¹, G. Tripepi2 , G. Crepaldi1, S. Maggi1, D’Angelo3, A. Naso4 , M. Plebani5, N.Vajente5, S. Giannini6, L. Calò7, D. Miozzo3 , R. Cristofaro3 and M. Gallieni8
1CNR Aging Section, Institute of Neuroscience, Padua, Italy;2CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases Hypertension of Reggio Calabria,Reggio Calabria , Italy; 3 Nephrology Unit, University of Padua, Italy; 4Nephrology and Dialysis Unit, Hospital of Padova 5Dipartimento di Medicina di Laboratorio, University-Hospital of Padova 6Department of Medical and Surgical Sciences, Clinica Medica 1, University of Padua, Italy;7Department of Clinical and Experimental Medicine, Medical Clinica 4, University of Padua – Italy; 8Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy
INTRODUCTIONS and AIM
METHODS
18 Italian dialysis centers, 387 hemodialysis (HD) patients (143 F, 37% ; 244 M, 63%), mean age 64±14 (SD) years, median dialytic age 49 months, BMI 25± 4 Kg/m2.
VF were evaluated with MorphoXpress, a tool for computerized analysis of scanned L-L vertebral X-rays. Reduction of >20% of vertebral body height was considered a VF, while reductions between 15% and 20% were considered borderline F (BF). Types of vertebral deformity differ when the reduction concerns the anterior, central or posterior dimension of the vertebra, respectively: wedge, biconcave or crush fractures [1] (Figure 1).
Using the same X-ray we evaluated the prevalence of vascular calcifications (VC) of the abdominal aorta, and of the iliac arteries (absence or presence). VC were quantified by measuring the length of calcific deposits along the arteries (mild cm, moderate cm and severe >10 cm) [2].
At least two different approaches are suitable for identifying vertebral fractures: one is a semiquantitative visual method, proposed by Genant [1], which involves an expert radiologist visually identifying the fractures and classifying them, according to the extent of the reduction in the dimension of the vertebral body, as mild (20–25%), moderate (25–40%) or severe (>40%), as illustrated in Figure 1; the other approach is a quantitative morphometric method. In particular, vertebral morphometry (VM) involves the manual or computerized measurement of the anterior, central and posterior dimensions of the dorsal and lumbar vertebral bodies (T4-L5) of the spine using conventional radiological apparatus (MRX: morphometric X-ray radiography) or densitometric apparatus (MXA: morphometric X-ray absorptiometry). Fig.1
Aim: We assessed the prevalence of VF in hemodialysis patients.
RESULTS
Biochemical parameters were: Ca 9.1±0.7 mg/dl, P 4.8± 1.3 mg/dl, median ALP 83 U/L, median PTH 243, median 25(OH)D 28.8 nmol/L (deficiency <10: 2.3%, insufficiency : 51.2% and normal > or equal 30: 46.5%).
They were not associated with VF. We found that 55% of patients had VF and 30.9% of patients had BF. Dorsal vertebral F (DVF) and Wedge F (WF) were predominant (see Graph1). Males had more VF than Females (60% versus 48%, P=0.019).
Prevalence of VC was 80.6% (mild 20.1%, moderate 30.8%, severe 29.7%) in the aorta and 55,1% in the iliac arteries .
No associations were found between VC and biochemical parameters. Age was associated with VC (p<0.001).
Fig.1
Graph 1. vertebral fractures in dialysis patients
REFERENCES:
CONCLUSIONS
1.Genant HK, Wu CY, Van Kuijk C et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8: 1137–1148
2. Witterman JC, Grobbee DE, Valkenburg HA et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis.Lancet 343: , 1994.
3. Rodríguez-García M, Gómez-Alonso C, Naves-Díaz M, Diaz-Lopez JB, Diaz-Corte C, Cannata-Andía JB; Asturias Study Group. Vascular calcifications, vertebral fractures and mortality in haemodialysis patients. Nephrol Dial Transplant 2009, 24:
Despite good control of bone and mineral metabolism parameters, VF and VC showed high prevalence in HD patients. Prevalence of VF assessed with Vertebral Morphometry is markedly higher than previously reported (3).
Predominantly dorsal and wedge VF and higher VF prevalence in males HD Patients have not been previously reported .
Corresponding Author
Fusaro, M.D.
CNR Aging Section, Institute of Neuroscience, Padua, Italy
Via Giustiniani, 2, Padova, Italy.
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