Preliminary study on osteoporosis screening among postmenopausal patients with maintenance hemodialysis_West China Medical Journal

Authors：

YAN Xueping ¹ ,  ZHOU Li ¹ , CHEN Lin ¹ , XIANG Ting ² , HAN Mei ²

1. Hemodialysis Center of Nephrology Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHOU Li, Email: 446125447@qq.com

Keywords：

Maintenance hemodialysis; Postmenopausal women; Osteoporosis; Fracture Risk Assessment Tool; Osteoporosis Self-assessment Tool for Asians

DOI：

10.7507/1002-0179.201905244

Video：

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Objective To preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).Methods Thirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.Results The DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.Conclusions Postmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.

Citation： YAN Xueping, ZHOU Li, CHEN Lin, XIANG Ting, HAN Mei. Preliminary study on osteoporosis screening among postmenopausal patients with maintenance hemodialysis. West China Medical Journal, 2019, 34(7): 764-768. doi: 10.7507/1002-0179.201905244 Copy

1.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
2.	何长民, 张训. 肾脏替代治疗. 上海: 上海科技教育出版社, 2005: 114-115.
3.	Choi HS, Park SY, Kim YM, et al. Medical treatment of severe osteoporosis including new concept of advanced severe osteoporosis. Osteoporos Sarcopenia, 2016, 2(1): 13-19.
4.	Avramovski P, Sikole A. The progression of bone mineral density loss in dialysis patients compared with the general population. Korean J Intern Med, 2012, 27(4): 436-442.
5.	Barreto FC, Barreto DV, Moyses RM, et al. Osteoporosis in hemodialysis patients revisited by bone histomorphometry: a new insight into an old problem. Kidney Int, 2006, 69(10): 1852-1857.
6.	蔡舒婷, 孙雯, 刘红. 骨折风险评估工具(FRAX®)在评价绝经后女性骨密度的临床意义. 中国骨质疏松杂志, 2017, 23(2): 177-182.
7.	景彩霞, 李二乐, 薛亚平. OSTA 指数与体重指数对于绝经后妇女骨质疏松的预测效果评价. 中国骨质疏松杂志, 2015, 21(2): 1083-1086.
8.	张寒, 甘华. 慢性肾脏病患者血管钙化与骨质疏松共同发生机制的研究进展. 医学综述, 2012, 18(18): 2991-2994.
9.	Zhang ZM, Qu YN, Sheng ZF, et al. How to decide in tervention thresholds based on FRAX in central south Chinese postmenopausal women. Endocrine, 2014, 45: 195-197.
10.	Su FM, Liu DH, Chen JF, et al. Development and validation of an Osteoporosis Self-Assessment Tool for Taiwan (OSTAi) postmenopausal women: a sub-study of the Taiwan OsteoPorosis Survey (TOPS). PLoS One, 2015, 10(6): e0130716.
11.	解冰, 田竞, 周大鹏, 等. 辽宁地区绝经后妇女骨质疏松症知识问卷调查分析. 中国骨质疏松杂志, 2014, 20(1): 73-77.
12.	Chen SJ, Chen YJ, Cheng CH, et al. Comparisons of different screening tools for identifying fracture/osteoporosis risk among community-dwelling older people. Medicine (Baltimore), 2016, 95(20): e3415.
13.	Collins AJ, Foley RN, Gilbertson DT. The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol, 2009, 4(Suppl 1): S5-S11.
14.	贾凤玉, 孟建中. 血液透析治疗模式和观念的研究进展. 中华临床医师杂志(电子版), 2013, 7(22): 174-176.
15.	丁婷婷, 王会玲, 陆石, 等. 血液透析患者微炎症状态与骨骼肌消耗性营养不良的临床研究. 中国中西医结合肾病杂志, 2013, 14(7): 582-585.
16.	王刚, 姜群, 张东亮, 等. 维持性血液透析患者骨质疏松患病情况及其危险因素分析. 临床和实验医学杂志, 2013, 12(16): 1277-1279.
17.	王超超, 林永强, 赵润英. 维持性血液透析患者骨密度分析. 浙江医学, 2018, 40(5): 484-485.
18.	王峥嵘, 朱昀. 老年慢性疾病患者骨质疏松的相关因素分析. 中华老年医学杂志, 2014, 33(3): 272-275.
19.	李桂英, 肖太玲, 秦燕. 慢性肾衰竭与骨质疏松的相关因素分析. 中国骨质疏松杂志, 2011, 17(5): 405-407.
20.	Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int, 2008, 19(4): 437-447.
21.	Kanis JA, McCloskey EV, Johansson H, et al. Case finding for the management of osteoporosis with FRAX®-assessment and intervention thresholds for the UK. Osteoporos Int, 2008, 19(10): 1395-1408.
22.	Fujiwara S, Nakamura T, Orimo H, et al. Development and application of a Japanese model of the WHO fraclare risk assessment tool (FRAX). Osteoporos Int, 2008, 19(4): 429-435.
23.	刘敏燕, 李春霖. 老年骨质疏松症的防治策略及进展. 中华老年多器官疾病杂志, 2013, 12(5): 397-400.
24.	Chang AJ, Ying Q, Chen XN, et al. Evaluation of three risk assessment tools in discriminating fracture status among Chinese patients undergoing hemodialysis. Osteoporos Int, 2016, 27(12): 3599-3606.
25.	钱慕周, 尹友生, 何勇, 等. 雌激素受体调节剂对血液透析女患者骨质疏松的作用. 中华肾脏病杂志, 2012, 28(3): 239-240.
26.	Miller PD. Bone disease in CKD: a focus on osteoporosis diagnosis and management. Am J Kidney Dis, 2014, 64(2): 290-304.
27.	左薇, 费琦, 杨雍, 等. BMD、OSTA 与 FRAX®预测绝经后女性骨质疏松性骨折风险的比较研究. 中国骨质疏松杂志, 2015, 21(1): 48-52.
28.	Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder: synopsis of the kidney disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med, 2018, 168(6): 422-430.

1. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
2. 何长民, 张训. 肾脏替代治疗. 上海: 上海科技教育出版社, 2005: 114-115.
3. Choi HS, Park SY, Kim YM, et al. Medical treatment of severe osteoporosis including new concept of advanced severe osteoporosis. Osteoporos Sarcopenia, 2016, 2(1): 13-19.
4. Avramovski P, Sikole A. The progression of bone mineral density loss in dialysis patients compared with the general population. Korean J Intern Med, 2012, 27(4): 436-442.
5. Barreto FC, Barreto DV, Moyses RM, et al. Osteoporosis in hemodialysis patients revisited by bone histomorphometry: a new insight into an old problem. Kidney Int, 2006, 69(10): 1852-1857.
6. 蔡舒婷, 孙雯, 刘红. 骨折风险评估工具(FRAX®)在评价绝经后女性骨密度的临床意义. 中国骨质疏松杂志, 2017, 23(2): 177-182.
7. 景彩霞, 李二乐, 薛亚平. OSTA 指数与体重指数对于绝经后妇女骨质疏松的预测效果评价. 中国骨质疏松杂志, 2015, 21(2): 1083-1086.
8. 张寒, 甘华. 慢性肾脏病患者血管钙化与骨质疏松共同发生机制的研究进展. 医学综述, 2012, 18(18): 2991-2994.
9. Zhang ZM, Qu YN, Sheng ZF, et al. How to decide in tervention thresholds based on FRAX in central south Chinese postmenopausal women. Endocrine, 2014, 45: 195-197.
10. Su FM, Liu DH, Chen JF, et al. Development and validation of an Osteoporosis Self-Assessment Tool for Taiwan (OSTAi) postmenopausal women: a sub-study of the Taiwan OsteoPorosis Survey (TOPS). PLoS One, 2015, 10(6): e0130716.
11. 解冰, 田竞, 周大鹏, 等. 辽宁地区绝经后妇女骨质疏松症知识问卷调查分析. 中国骨质疏松杂志, 2014, 20(1): 73-77.
12. Chen SJ, Chen YJ, Cheng CH, et al. Comparisons of different screening tools for identifying fracture/osteoporosis risk among community-dwelling older people. Medicine (Baltimore), 2016, 95(20): e3415.
13. Collins AJ, Foley RN, Gilbertson DT. The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol, 2009, 4(Suppl 1): S5-S11.
14. 贾凤玉, 孟建中. 血液透析治疗模式和观念的研究进展. 中华临床医师杂志(电子版), 2013, 7(22): 174-176.
15. 丁婷婷, 王会玲, 陆石, 等. 血液透析患者微炎症状态与骨骼肌消耗性营养不良的临床研究. 中国中西医结合肾病杂志, 2013, 14(7): 582-585.
16. 王刚, 姜群, 张东亮, 等. 维持性血液透析患者骨质疏松患病情况及其危险因素分析. 临床和实验医学杂志, 2013, 12(16): 1277-1279.
17. 王超超, 林永强, 赵润英. 维持性血液透析患者骨密度分析. 浙江医学, 2018, 40(5): 484-485.
18. 王峥嵘, 朱昀. 老年慢性疾病患者骨质疏松的相关因素分析. 中华老年医学杂志, 2014, 33(3): 272-275.
19. 李桂英, 肖太玲, 秦燕. 慢性肾衰竭与骨质疏松的相关因素分析. 中国骨质疏松杂志, 2011, 17(5): 405-407.
20. Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int, 2008, 19(4): 437-447.
21. Kanis JA, McCloskey EV, Johansson H, et al. Case finding for the management of osteoporosis with FRAX®-assessment and intervention thresholds for the UK. Osteoporos Int, 2008, 19(10): 1395-1408.
22. Fujiwara S, Nakamura T, Orimo H, et al. Development and application of a Japanese model of the WHO fraclare risk assessment tool (FRAX). Osteoporos Int, 2008, 19(4): 429-435.
23. 刘敏燕, 李春霖. 老年骨质疏松症的防治策略及进展. 中华老年多器官疾病杂志, 2013, 12(5): 397-400.
24. Chang AJ, Ying Q, Chen XN, et al. Evaluation of three risk assessment tools in discriminating fracture status among Chinese patients undergoing hemodialysis. Osteoporos Int, 2016, 27(12): 3599-3606.
25. 钱慕周, 尹友生, 何勇, 等. 雌激素受体调节剂对血液透析女患者骨质疏松的作用. 中华肾脏病杂志, 2012, 28(3): 239-240.
26. Miller PD. Bone disease in CKD: a focus on osteoporosis diagnosis and management. Am J Kidney Dis, 2014, 64(2): 290-304.
27. 左薇, 费琦, 杨雍, 等. BMD、OSTA 与 FRAX®预测绝经后女性骨质疏松性骨折风险的比较研究. 中国骨质疏松杂志, 2015, 21(1): 48-52.
28. Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder: synopsis of the kidney disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med, 2018, 168(6): 422-430.

West China Medical Journal

Preliminary study on osteoporosis screening among postmenopausal patients with maintenance hemodialysis

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