Journal of Bone and Mineral Metabolism

, Volume 37, Issue 1, pp 81–89 | Cite as

Association between frailty and bone loss in patients undergoing maintenance hemodialysis

  • Kei Yoneki
  • Jun Kitagawa
  • Keika Hoshi
  • Manae Harada
  • Takaaki Watanabe
  • Takahiro Shimoda
  • Ryota Matsuzawa
  • Atsushi Yoshida
  • Yusuke Matsunaga
  • Yasuo Takeuchi
  • Kentaro Kamiya
  • Atsuhiko MatsunagaEmail author
Original Article


Frailty is significantly associated with bone loss in the general population. However, it is unclear whether this association also exists in patients undergoing hemodialysis who have chronic kidney disease-mineral and bone disorder (CKD-MBD). This study aimed to assess the association between frailty and bone loss in patients undergoing hemodialysis. This cross-sectional study included 214 (90 women, 124 men) Japanese outpatients undergoing maintenance hemodialysis three times per week, with a mean age of 67.1 years (women) and 66.8 years (men). Frailty was defined based on criteria set forth by the Cardiovascular Health Study (CHS)—19 (21.1%) women and 47 (37.9%) men were robust, 41 (45.6%) women and 43 (34.7%) men were pre-frail, and 30 (33.3%) women and 34 (27.4%) men were frail. For bone mass, quantitative ultrasound (QUS) parameters (speed of sound, broadband ultrasound attenuation, stiffness index) of the calcaneus were measured. The association between frailty and QUS parameters was determined separately for women and men using multivariate analysis of covariance (ANCOVA), with adjustments for clinical characteristics including age, body mass index, hemodialysis vintage, diabetes, current smoking, serum albumin, phosphate, corrected calcium, intact parathyroid hormone, and medication for CKD-MBD (vitamin D receptor activator, calcimimetics). ANCOVA revealed that all QUS parameters declined significantly with increasing levels of frailty in both sexes (P < 0.05). In conclusion, frailty (as defined by CHS criteria) should be considered a risk factor for bone loss in patients undergoing hemodialysis.


Frailty Hemodialysis QUS Bone mass CKD-MBD 



We thank all investigators and contributors to our study. This study was supported by JSPS KAKENHI (Grant Number 23500614). The funders had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of the paper. The views expressed in this publication are those of the authors and not those of the funders.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare.


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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Kei Yoneki
    • 1
    • 2
  • Jun Kitagawa
    • 1
  • Keika Hoshi
    • 3
  • Manae Harada
    • 1
    • 2
  • Takaaki Watanabe
    • 1
    • 2
  • Takahiro Shimoda
    • 1
    • 2
  • Ryota Matsuzawa
    • 4
  • Atsushi Yoshida
    • 2
  • Yusuke Matsunaga
    • 2
    • 5
  • Yasuo Takeuchi
    • 6
  • Kentaro Kamiya
    • 1
  • Atsuhiko Matsunaga
    • 1
    Email author
  1. 1.Department of Rehabilitation Sciences, Graduate School of Medical SciencesKitasato UniversitySagamiharaJapan
  2. 2.Department of Hemodialysis CenterSagami Circulatory Organ ClinicSagamiharaJapan
  3. 3.Department of HygieneKitasato University School of MedicineSagamiharaJapan
  4. 4.Department of RehabilitationKitasato University HospitalSagamiharaJapan
  5. 5.Department of Sleep Medicine, Graduate School of Medical SciencesKitasato UniversitySagamiharaJapan
  6. 6.Division of Nephrology, Department of Internal MedicineKitasato University School of MedicineSagamiharaJapan

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