The Clinical Application of FRAX with Bone Mineral Density (BMD) Measurement in Patients Undergoing Hemodialysis in Baqiyatallah Hospital

Patients with end-stage renal disease (ESRD) are at risk for fractures and bone disorders approximately 17 times more than the general population. Evaluating fracture risk in patients with ESRD in the dialysis department of the hospital, can provide useful information to the treatment for staff and researchers. The Fracture Risk Assessment Tool (FRAX®) algorithm is used along with dual-energy x-ray absorptiometry (DXA) or bone densitometry and is capable in predicting the rate of 10-year probability of hip and major osteoporotic fracture (MOF) in a certain group of patients.

This cross-sectional study was conducted to evaluate the fracture risk in 107 hemodialysis patients, who underwent hemodialysis three times a week for 4 hours in 2018 in Baqiyatullah Hospital. Patients who have done bone densitometry and for whom the standardized FRAX questionnaire of the World Health Organization was filled were included in the study.

The mean age of the participants was 59.95 ± 14.18 years and 58.2% of them were male. The average levels of calcium, phosphorus, parathyroid hormone, albumin, and vitamin D were determined to be 8.40 ± 1.14 mg/dL, 4.97 ± 1.41 mg/dL, 269.40 ± 297.66 ng/ml, 3.86 ± 0.49 g/dL, 22.15 ± 13.93 nmol/L and -2.08 ± 1, respectively. The minimum, mean and maximum values of BMD were found to be -5.30, -2.09, and -2.20, respectively. The FRAX scores of hip fracture and MOFs with BMD were 5.01 and 8.81, respectively, while the corresponding values for FRAX scores of hip fracture and MOFs without BMD were determined 2.23 and 5.82, respectively. A significant difference was observed between FRAX scores with and without BMD. Furthermore, a statistically significant difference was found between MOFs and hip fracture risk values ​​calculated with and without BMD. In our study, the patient's previous fracture history predicts a higher hip FRAX score in the future, but the parents' hip fracture history had no effect on the hip FRAX score. We also found that the increase in PTH level had an increasing effect on the FRAX score of the hip joint. The results demonstrated that increasing the height and BMD of patients can significantly reduce the FRAX score related to MOFs and tight, while this index increases with increasing age of patients and PTH. In our study, thin and short patients are prone to more fractures in the hip joint.

Our finding suggests that FRAXB with MD may be a valuable tool for clinicians in this center to accurately assess fracture risk in ESRD patients and ultimately reduce treatment costs. We encourage nephrologists to pay close attention to this algorithm information.