Nephrology Dialysis Transplantation, May 2014
Introduction and Aims: Vertebral Fractures (VFs) are common in the general population and in Chronic Kidney Disease patients. VFs are associated with vascular calcifications (VCs) and to an increased risk of mortality. The Spine Deformity Index (SDI) is a summary measure of the VFs status, incorporating both the number and severity of VFs in a score. The aim of this study was to evaluate the relationships between the classic SDI, laboratory parameters of bone metabolism, and vascular calcifications within the context of the EVERFRACT study. Methods: In 387 hemodialysis patients, aged 64.2 ± 14.1 years, we determined routine biochemical parameters and: 25(OH)vitamin D, total Bone Gla Protein (BGP), undercarboxylated BGP (ucBGP) and total Matrix Gla Protein (MGP). We performed laterolateral x-Rays of the spine (T5 to L4) to evaluate both VFs (defined as reduction > 20% in vertebral body height) by Quantitative Vertebral Morphometry and VCs, aortic (AoVC) and iliac (IaVC), by Witteman’s method. We divided the SDI score by the number of fractures, in order to obtain a more precise index of fracture severity (corrected-SDI: c-SDI). Results: We found a high prevalence (55.3%, n=214) of VFs. The mean SDI was 1.4 ± 1.74. The mean c-SDI was 0.74 ± 0.75. VFs had a grade of severity that was low through T5-T10 and higher through T11-L3. The severity of fractures was highlighted only by c-SDI (see Table). We found 80.6% of AAoC and 55.6% of IAC. SDI was significantly associated with AAoC (OR=1.15, 95% CI 1.02-1.30, p=0.023). A SDI >1 was significantly associated with: sex (male OR 1.86, 95% CI 1.20-2.91, p=0.007), age (OR 1.03, 95% 1.01-1.05, p=0.0003) and albumin ≥ 3.5 g/dL (OR 0.54, 95% CI 0.31-0.93, p=0.026). c-SDI score was significantly associated with AAoC (OR=1.48, 95% CI 1.11-1.98, p=0.0009) and with IAC (OR=1.54, 95% CI 1.06-2.24, p=0.025). A c-SDI >1 was significantly associated with: age (OR 1.05, 95% CI 1.03-1.07, p<0.0001), LDL Cholesterol ≥ 90 mg/dL (OR 1.74, 95% 1.04-2.92, p=0.0354) and ucBGP ≥ 17.2 mcg/L (OR 0.35, 95% CI 0.18-0.70, p=0.0025). Conclusions: SDI and c-SDI score associated with bone and vascular markers. c-SDI score performed better in the evaluation of the grade of fracture severity and it showed a stronger association with VC and vascular markers. This is the first time that the association of SDI with bone biochemical parameters and VC has been reported. View this table: In this window In a new window
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Maria Fusaro, Sandro Giannini, Davide Miozzo, Marianna Noale, Giovanni Tripepi, Mario Plebani, Martina Zaninotto, Antonio Piccoli, Maria Teresa Vilei, Rosalba Cristofaro, Maurizio Gallieni, Kae Hamamoto, Masaaki Inaba, Senji Okuno, Yasuo Imanishi, Eiji Ishimura, Tomoyuki Yamakawa, Shigeichi Shoji, Hansjörg M Rothe, Philipp Eller, Gert Mayer, Markus Ketteler, Reinhard Kramar, Faissal Shaheen, Mona Al Rukhaimi, Ali Alsahow, Fadwa Al-Ali, Issa Al Salmi, Sumaya Al Ghareeb, Mia Wang, Brian Bieber, Bruce M Robinson, Ronald L Pisoni, Jacek Waniewski, Malgorzata Debowska, Alicja Wojcik-Zaluska, Andrzej Ksiazek, Wojciech Zaluska, Marc E. De Broe, Rosamund J. Wilson, J. Brian Copley, Rikako Hiramtasu, Yoshifumi Ubara, Junichi Hoshino, Kenmei Takaichi, Farid Girgis Ghalli, Farid Girgis Ghalli, Rajiva Ibakkanavar, James Chess, Gareth Roberts, Steve Riley, Alline S.A. Oliveira, Clarissa J.B. Carvalho, Camila B L Oliveira, Carla T B C Pessoa, Rodrigo A S Leão, José Edevanilson B Gueiros, Ana Paula S Gueiros, Kazuhiro Okano, Yuki Tsuruta, Asako Hibi, Misao Tsukada, Naoko Miwa, Naoki Kimata, Ken Tsuchiya, Takashi Akiba, Kosaku Nitta, Masahide Mizobuchi, Hiroaki Ogata, Nozomu Hosaka, Daisuke Sanada, Noriko Arai, Fumihiko Koiwa, Eriko Kinugasa, Takanori Shibata, Tadao Akizawa, Pierre Delanaye, Jean-Marie Krzesinski, Xavier Warling, Martial Moonen, Nicole Smelten, Laurent Médart, Hans Pottel, Etienne Cavalier, Pierre Delanaye, Jean-Claude Souberbielle, Romy Gadisseur, Bernard E Dubois, Jean-Marie Krzesinski, Etienne Cavalier, Patrícia Matias, Cristina Jorge, Marco Mendes, Ana Azevedo, David Navarro, Carina Ferreira, Tiago Amaral, Inês Aires, Célia Gil, Aníbal Ferreira, Hiroshi Kikuchi, Hisaki Shimada, Ryo Karasawa, Masashi Suzuki, Won Suk An, Su Mi Lee, You Jeong Oh, Young Ki Son, Luciano De Paola, Gianmarco Lombardi, Maria Teresa Panzino, Luigi Lombardi, Helmut Reichel, Kai-Michael Hahn, Matthias Kohnle, Christina Guggenberger, Frank Delanna, Naomi Sasaki, Masataka Tsunoda, Ryota Ikee, Nobuo Hashimoto, Laura Sola, Maria Noel Leyun, Juan Carlos Diaz, Cristina Sehabiague, Susana Gonzalez, Walter Alallon, Kateri Bourbeau, Chloé Lajoie, Fabrice Macway, Takayuki Fujii, Satoshi Suzuki, Mizuki Shinozaki, Hiroaki Tanaka, Matthias Klingele, Sarah Seiler, Aaron Poppleton, Philipp Lepper, Danilo Fliser, Roland Seidel, Lide Lun, Dong Liu, Xinlun Li, Xueming Wei, Jing Miao, Zuo Gao, Ruihai Hu, Luciano De Paola, Gianmarco Lombardi, Maria Teresa Panzino, Luigi Lombardi, Blanca Gros, Antonio Galán, Emilio González-Parra, José Antonio Herrero, María Echave, Stefan Vegter, Keith Tolley, Itziar Oyagüez, Florian S. Gutzwiller, Peter G Braunhofer, Thomas D. Szucs, Matthias Schwenkglenks, Vural Taner Yilmaz, Sebahat Ozdem, Levent Donmez, Huseyin Kocak, Ayhan Dinckan, Ramazan Cetinkaya, Gultekin Suleymanlar, Fettah Fevzi Ersoy. DIALYSIS BONE DISEASE, Nephrology Dialysis Transplantation, 2014, pp. iii263-iii271, 29/suppl 3, DOI: 10.1093/ndt/gfu157