Low bone mineral density and fractures in stages 3-5 CKD: an updated systematic review and meta-analysis
Low bone mineral density and fractures in stages 3-5 CKD: an updated systematic review and meta-analysis
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DOI：
10.1007/s00198-014-2813-3
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发表时间：
2015-02-01
影响因子：
4
通讯作者：
Jamal, S. A.
中科院分区：
文献类型：
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作者：
Bucur, R. C.;Panjwani, D. D.;Jamal, S. A.
骨密度(BMD)测试在慢性肾脏疾病(CKD)中的应用尚不清楚。我们对有关CKD患者骨密度和骨折的研究进行了荟萃分析。除一项研究外，所有研究都是横断面研究。有CKD和骨折的患者的骨密度比无骨折的患者低。CKD与骨折风险增加有关。目前尚不清楚双能X线骨密度仪(DXA)在慢性肾脏病(CKD)中评估骨折风险的作用。我们对有关透析前和透析CKD中DXA与骨折(形态测量脊柱或临床非脊柱)相关性的已发表研究进行了最新的荟萃分析和系统综述。我们确定了2,894篇潜在的文献，检索了292篇用于详细综述的文献，其中包括13篇。除一篇研究外，其余研究均为横断面研究，其中三篇报道了DXA在透析前慢性肾脏病中鉴别骨折状态的能力。结果用随机效应模型合并，并用I(2)统计方法评估统计学异质性。无论透析状态如何，有骨折的受试者股骨颈、腰椎、1/3和超尺骨的BMD在统计学上显著低于无骨折的受试者。例如，与没有骨折的患者相比，透析患者的股骨颈骨密度低0.06g/cm(2)，透析前有骨折的患者股骨颈骨密度低0.102 g/cm(2)。与未发生骨折的患者相比，透析组腰椎骨密度降低0.05g/cm(2)，透析前骨折组腰椎骨密度降低0.108 g/cm(2)。我们的荟萃分析仅限于受试者数量较少、骨折数量较少的研究。所有的研究都是观察性的，只有一项是前瞻性的。腰椎、腰椎1/3和超胫骨的骨密度具有统计学上的异质性。我们的研究结果表明，骨密度可以区分透析前和透析后CKD的骨折状态。需要更大规模的前瞻性研究。
The utility of bone mineral density (BMD) testing in chronic kidney disease (CKD) is not known. We performed a meta-analysis of studies reporting on BMD and fracture in CKD. All but one study was cross-sectional. BMD was lower in those with CKD and fractures compared to those without fractures.CKD is associated with an increased risk of fracture. The utility of dual energy X-ray absorptiometry (DXA) to assess fracture risk in CKD is unknown.We performed an updated meta-analysis and systematic review of published studies that reported on the association between DXA and fracture (morphometric spine or clinical nonspine) in predialysis and dialysis CKD. We identified 2,894 potential publications, retrieved 292 for detailed review, and included 13. All but one study was cross-sectional and three reported on the ability of DXA to discriminate fracture status in predialysis CKD. Results were pooled using a random effects model and statistical heterogeneity was assessed using the I (2) statistic.BMD was statistically significantly lower at the femoral neck, lumbar spine, the 1/3 and ultradistal radius in subjects with fractures compared to those without regardless of dialysis status. For example, femoral neck BMD was 0.06 g/cm(2) lower in dialysis subjects and 0.102 g/cm(2) lower in predialysis subjects with fractures compared to those without. Lumbar spine BMD was 0.05 g/cm(2) lower in dialysis subjects and 0.108 g/cm(2) lower in predialysis subjects with fractures compared to those without. Our meta-analysis was limited to studies with small numbers of subjects and even smaller numbers of fractures. All of the studies were observational and only one was prospective. There was statistical heterogeneity at the lumbar spine, 1/3 and ultradistal radius.Our findings suggest that BMD can discriminate fracture status in predialysis and dialysis CKD. Larger, prospective studies are needed.