Bone mineral density loss faster in those with kidney disease
Feb 6, 2010 - 3:20:08 PM

Even slight kidney impairment can speed up the loss of bone mineral density (BMD) among older people, putting them at risk of potentially disabling fractures, new research shows.

“Our findings highlight the importance of estimating kidney function when evaluating patients for fracture risk,” Sophie A. Jamal, MD, PhD, of the University of Toronto and her colleagues say in the February issue of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.

Most people who have chronic kidney disease (CKD), or who are at risk for this condition, don’t know it, points out Dr. Kerry Willis, senior vice president for scientific activities at the National Kidney Foundation. “The new findings show the potential impact of early identification of kidney disease in preventing complications that can cause disability and premature death,” Dr. Willis said.

When a person’s kidney function is completely lost—a condition known as end-stage renal disease—he or she is at much greater risk of sustaining a hip fracture, Dr. Jamal and her colleagues explain in their report.

To better understand the relationship between more modest kidney impairment and bone loss, the researchers followed 191 men and 444 women age 50 and older for five years. They used two different techniques—estimated creatinine clearance and estimated glomerular filtration rate—to gauge patients’ kidney function at the beginning of the study. The first test measures how quickly the kidneys clear creatinine (a waste product), from the blood, and the second gauges the speed at which fluid flows through the kidney. Study participants also had their BMD measured at the beginning of the study and five years later.
Dr. Jamal and her team found that the people with impaired kidney function lost BMD faster than those whose kidneys were working normally. For example, the study participants with the worst kidney function showed a 9.3 percent greater decrease in their lower spine BMD over a five-year period compared to those with normally functioning kidneys. The results were basically the same with either kidney function measure.

“Not only is this a substantial loss, but equally concerning is that the bone loss occurs with even modest impairment of kidney function,” Dr. Jamal and her colleagues say.

To date, the National Kidney Foundation’s Kidney Early Evaluation Program (KEEP) has screened 130,000 high-risk individuals for CKD, Dr. Willis said. Anyone 18 and older who has high blood pressure, diabetes or a family history of kidney disease should be screened for CKD, she added, which can be done with three simple tests: blood pressure measurement, a urine test for the presence of a protein called albumin, and a blood test for creatinine.

“Osteoporosis can lead to potentially disabling fractures of the spine and hip,” she added. “Physicians should understand that even a slight decline of kidney function in their older patients could mean an increased risk of osteoporosis.”

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