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Low bone mineral density (BMD) and trabecular bone score (TBS) are established risk factors for fractures even in hemodialysis population and they seem to be significantly lower in comparison with general population. The aim of our study was to describe 2-year loss of BMD and TBS and their predictors in hemodialysis patients. From 59 non-selected patients (mean age 67.6 ± 13.1 years) from one dialysis centre, treated with hemodiafiltration (HDF), clinical and laboratory characteristics were obtained and densitometry examinations (with BMD and TBS results) were performed initially and at the end of 2-year follow-up. Two-year decrease in BMD of lumbar spine reached 4.1% (ns), of proximal femur 9.1% (p = 0.004), and of femoral neck 1.3% (ns). In the co-educated cohort, BMD decrease in all the sites correlated significantly with age and only the change of BMD of lumbar spine was negatively associated with serum calcium (r = − 0.39; p = 0.04) and dialysis vintage (r = − 0.387; p = 0.062), no other predictors of BMD loss were identified. Some predictors of BMD loss were identified with regard to gender. TBS decrease was 0.05 (3.9%; p = 0.03), and similarly, it was not predicted by any of selected parameters. No differences in BMD changes or TBS were observed between the patients with and without fractures. In patients with HDF, significant BMD and TBS annual losses were observed, and they were associated only with age and (in BMD of lumbar spine) with serum calcium and dialysis vintage.

Bone involvement represents one of the complications of end-stage chronic kidney disease, with fractures being its major risk. The aim of our study was to assess the frequency and predictors of low-trauma fractures in a cohort of maintenance hemodialysis patients followed-up on for 2 years. 59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafiltration underwent initially laboratory (markers of calcium–phosphate metabolism and bone turnover markers) and densitometry examination with TBS assessment (Lunar Prodigy, TBS software 2.1.2). During 24-month follow-up, the frequency of low-trauma fractures was assessed and possible predictors of increased fracture risk were identified using product–moment correlation matrices. Altogether 7 (11.9%) low-trauma fractures were observed. In the whole group, age (P = 0.047), T-score in proximal femur (P = 0.04), low vitamin D, low BMI (P = 0.03 for both), and higher FRAX for major osteoporotic fracture (P = 0.01) were connected with fractures, but in multi-variate analysis only BMI remained significantly negatively associated with fractures (P = 0.047). TBS and bone turnover markers failed to predict fractures. However, women with fractures had significantly lower serum phosphate (P = 0.03) and higher parathyroid hormone (P = 0.04). Parameters of hip structure analysis significantly correlated with FRAX, but not with fractures. In a group of hemodialysis patients from one centre, T-score in proximal femur, low vitamin D, low BMI, and high FRAX for major osteoporotic fracture were associated with low-trauma fractures, however, in multi-variate analysis only low BMI remained a significant predictor of fracture risk.

Background/Aims: Small attention is paid to other types of bone diseases then chronic kidney disease-mineral and bone disorder in dialysis patients. The aim of our study was to assess the occurrence of osteoporosis and bone microarchitecture by trabecular bone score in this population. Methods: 59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafIltration underwent densitometry (Lunar Prodigy, TBS software 2.1.2) and laboratory assessment. Results: Osteoporosis was observed in 34% patients, high bone turnover was found in 80% of them, with SHPT (PTH > 300 ng/l) present in 69%. TBS was significantly decreased in 47.5% of the patients. TBS correlated with T- and Z-scores of the lumbar spine and proximal femur in the total population (P < 0.0001) and in men (P < 0.00001) and there were significant differences between TBS in groups with normal densitometry, osteopenia, and osteoporosis, both in total population (P < 0.0001; P < 0.01) and in men (P < 0.001; P < 0.001). Conclusions: Osteoporosis was found in about 1/3 of patients treated with hemodiafiltration. Normal TBS was found in only 1/4 of the dialysis population. TBS correlated with densitometric parameters and was significantly different relative to T-scores.