Chronic kidney disease is associated with low BMD at the hip but not at the spine

  • K. S. Bezerra de Carvalho
  • R.F.V. Vasco
  • M.R. Custodio
  • V. Jorgetti
  • R.M.A. Moysés
  • R.M. EliasEmail author
Original Article



Although chronic kidney disease is associated with other bone disorders, osteoporosis can be found in this context, and it is defined based on bone mineral density (BMD), measured by dual-energy X-ray absorptiometry. As CKD progresses, the percentage of normal BMD decreases, whereas that of osteopenia/osteoporosis increases, mostly due to hip involvement, particularly in patients with reduced renal function.


Osteoporosis is a highly prevalent disease in patients with chronic kidney disease (CKD). We investigated the features of bone mineral density (BMD) in patients with assorted kidney diseases and hypothesized that low BMD, as measured by dual-energy X-ray absorptiometry (DXA), would be more prevalent as kidney function decreased and would correlate with biomarkers of mineral and bone disease.


DXA obtained from January 1, 2008, to December 31, 2017, clinical, demographic, and biochemical data at the time of image acquisition were recorded. Data from 1172 patients were included in this study (81.3% women, 79.9% white, and 8.1% diabetic).


Osteopenia and osteoporosis in at least one site (total hip or spine) were found in 32.7% and 20.0% of patients, respectively. As CKD progressed, the percentage of patients with normal BMD decreased, whereas the percentage of osteopenia and osteoporosis increased, which was mostly due to the total hip involvement, particularly in patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. Older age and hyperparathyroidism were independent risk factors for osteopenia/osteoporosis at the total hip; female gender, older age, and higher iCa were independently associated with the risk of osteopenia/osteoporosis at the spine. With eGFR > 90 ml/min as reference, the odds ratios for osteoporosis/osteopenia at the hip were 1.51 (95% CI 1.01–2.24) and 1.91 (95% CI 1.13–3.20) for patients with eGFR 30–60 and 15–30 ml/min/1.73 m2, respectively. No CKD stage was significantly associated with the risk of osteoporosis/osteopenia at the spine.


Our results highlighted that low BMD in patients with CKD is associated with age and hyperparathyroidism, and affects predominantly the hip.


Bone mineral density Chronic kidney disease DXA Hip Osteoporosis Parathyroid hormone 



We thank Fatima Libânio for her assistance in collecting the electronic data.

Author contributions

Authors’ roles: Study design: KSBC, and RME. Study conduct: KSBC, RFVV, MRC, VJ, RMAM, and RME. Data collection: KSBC, RFVV, and RME. Data analysis: KSBC, RMAM, and RME. Data interpretation: KSBC, MRC, VJ, RMAM, and RME. Drafting manuscript: KSBC, RMAM and RME. Revising manuscript content: KSBC, MRC, VJ, RMAM, and RME. Approving final version of manuscript: KSBC, RFVV, MRC, VJ, RMAM, and RME. RME takes responsibility for the integrity of the data analysis.

Compliance with ethical standards

Conflicts of interest

KSBC, MRC, and RME have nothing to declare. VJ and RMAM are financially supported by CNPq, Conselho Nacional de Desenvolvimento Científico e Tecnológico (grant numbers 303684/2013-5 and 304249/2013-0, respectively). This financial support had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.

Supplementary material

198_2019_4864_MOESM1_ESM.doc (30 kb)
ESM 1 (DOC 30 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • K. S. Bezerra de Carvalho
    • 1
  • R.F.V. Vasco
    • 1
  • M.R. Custodio
    • 1
  • V. Jorgetti
    • 1
    • 2
  • R.M.A. Moysés
    • 1
    • 3
  • R.M. Elias
    • 1
    • 3
    Email author
  1. 1.Nephrology Service, Hospital das Clinicas HCFMUSPUniversidade de Sao PauloSão PauloBrazil
  2. 2.Hospital SamaritanoSão PauloBrazil
  3. 3.Universidade Nove de JulhoSão PauloBrazil

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