Discriminants of prevalent fractures in chronic kidney disease

Thomas L. Nickolas, Serge Cremers, Amy Zhang, Valeri Thomas, Emily Stein, Adi Cohen, Ryan Chauncey, Lucas Nikkel, Michael T. Yin, Xiaowei S. Liu, Stephanie Boutroy, Ronald B. Staron, Mary B. Leonard, Donald J. McMahon, Elzbieta Dworakowski, Elizabeth Shane

Research output: Contribution to journalArticlepeer-review

113 Scopus citations


Patients with chronic kidney disease (CKD) have higher rates of fracture than the general population. Increased bone remodeling, leading to microarchitectural deterioration and increased fragility, may accompany declining kidney function, but there are no reliable methods to identify patients at increased risk for fracture. In this cross-sectional study of 82 patients with predialysis CKD, high-resolution imaging revealed that the 23 patients with current fractures had significantly lower areal density at the femoral neck; total, cortical, and trabecular volumetric bone density; cortical area and thickness; and trabecular thickness. Compared with levels in the lowest tertile, higher levels of osteocalcin, procollagen type-1 N-terminal propeptide, and tartrate-resistant acid phosphatase 5b were associated with higher odds of fracture, even after adjustment for femoral neck T-score. Discrimination of fracture prevalence was best with a femoral neck T-score of -2.0 or less and a value in the upper two tertiles for osteocalcin, procollagen type-1 N-terminal propeptide, or tartrate-resistant acid phosphatase 5b; these values corresponded to the upper half of the normal premenopausal reference range. In summary, these cross-sectional data suggest that measurement of bone turnover markers may increase the diagnostic accuracy of densitometry to identify patients with CKD at high risk for fracture.

Original languageEnglish (US)
Pages (from-to)1560-1572
Number of pages13
JournalJournal of the American Society of Nephrology
Issue number8
StatePublished - Aug 2011

All Science Journal Classification (ASJC) codes

  • General Medicine


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