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.	何長民, 張訓. 腎臟替代治療. 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, 孫雯, 劉紅. 骨折風險評估工具(FRAX?)在評價絕經后女性骨密度的臨床意義. 中國骨質疏松雜志, 2017, 23(2): 177-182.
7.	景彩霞, 李二樂, 薛亞平. OSTA 指數與體重指數對于絕經后婦女骨質疏松的預測效果評價. 中國骨質疏松雜志, 2015, 21(2): 1083-1086.
8.	張寒, 甘華. 慢性腎臟病患者血管鈣化與骨質疏松共同發生機制的研究進展. 醫學綜述, 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, 田競, 周大鵬, 等. 遼寧地區絕經后婦女骨質疏松癥知識問卷調查分析. 中國骨質疏松雜志, 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.	賈鳳玉, 孟建中. 血液透析治療模式和觀念的研究進展. 中華臨床醫師雜志(電子版), 2013, 7(22): 174-176.
15.	丁婷婷, 王會玲, 陸石, 等. 血液透析患者微炎癥狀態與骨骼肌消耗性營養不良的臨床研究. 中國中西醫結合腎病雜志, 2013, 14(7): 582-585.
16.	王剛, 姜群, 張東亮, 等. 維持性血液透析患者骨質疏松患病情況及其危險因素分析. 臨床和實驗醫學雜志, 2013, 12(16): 1277-1279.
17.	王超超, 林永強, 趙潤英. 維持性血液透析患者骨密度分析. 浙江醫學, 2018, 40(5): 484-485.
18.	王崢嶸, 朱昀. 老年慢性疾病患者骨質疏松的相關因素分析. 中華老年醫學雜志, 2014, 33(3): 272-275.
19.	李桂英, 肖太玲, 秦燕. 慢性腎衰竭與骨質疏松的相關因素分析. 中國骨質疏松雜志, 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.	劉敏燕, 李春霖. 老年骨質疏松癥的防治策略及進展. 中華老年多器官疾病雜志, 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.	錢慕周, 尹友生, 何勇, 等. 雌激素受體調節劑對血液透析女患者骨質疏松的作用. 中華腎臟病雜志, 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, 費琦, 楊雍, 等. BMD、OSTA 與 FRAX?預測絕經后女性骨質疏松性骨折風險的比較研究. 中國骨質疏松雜志, 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. 何長民, 張訓. 腎臟替代治療. 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, 孫雯, 劉紅. 骨折風險評估工具(FRAX?)在評價絕經后女性骨密度的臨床意義. 中國骨質疏松雜志, 2017, 23(2): 177-182.
7. 景彩霞, 李二樂, 薛亞平. OSTA 指數與體重指數對于絕經后婦女骨質疏松的預測效果評價. 中國骨質疏松雜志, 2015, 21(2): 1083-1086.
8. 張寒, 甘華. 慢性腎臟病患者血管鈣化與骨質疏松共同發生機制的研究進展. 醫學綜述, 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, 田競, 周大鵬, 等. 遼寧地區絕經后婦女骨質疏松癥知識問卷調查分析. 中國骨質疏松雜志, 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. 賈鳳玉, 孟建中. 血液透析治療模式和觀念的研究進展. 中華臨床醫師雜志(電子版), 2013, 7(22): 174-176.
15. 丁婷婷, 王會玲, 陸石, 等. 血液透析患者微炎癥狀態與骨骼肌消耗性營養不良的臨床研究. 中國中西醫結合腎病雜志, 2013, 14(7): 582-585.
16. 王剛, 姜群, 張東亮, 等. 維持性血液透析患者骨質疏松患病情況及其危險因素分析. 臨床和實驗醫學雜志, 2013, 12(16): 1277-1279.
17. 王超超, 林永強, 趙潤英. 維持性血液透析患者骨密度分析. 浙江醫學, 2018, 40(5): 484-485.
18. 王崢嶸, 朱昀. 老年慢性疾病患者骨質疏松的相關因素分析. 中華老年醫學雜志, 2014, 33(3): 272-275.
19. 李桂英, 肖太玲, 秦燕. 慢性腎衰竭與骨質疏松的相關因素分析. 中國骨質疏松雜志, 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. 劉敏燕, 李春霖. 老年骨質疏松癥的防治策略及進展. 中華老年多器官疾病雜志, 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. 錢慕周, 尹友生, 何勇, 等. 雌激素受體調節劑對血液透析女患者骨質疏松的作用. 中華腎臟病雜志, 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, 費琦, 楊雍, 等. BMD、OSTA 與 FRAX?預測絕經后女性骨質疏松性骨折風險的比較研究. 中國骨質疏松雜志, 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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