FP421PROGNOSTIC SIGNIFICANCE OF THE PRESENCE OF VERTEBRAL FRACTURES IN THE SURVIVAL OF CHRONIC KIDNEY DISEASE PATIENTS STAGES 3-5 NOT ON DIALYSIS

Abstract

Introduction and Aims: There are little data concerning the prevalence of vertebral fractures (VF) , risk factors for fracture and relationship between fractures and mortality in individuals with chronic kidney disease (CKD). To address this knowledge gap we conducted a “post hoc” analysis using data from the OSERCE II study (a 3-year follow-up prospective multicenter study which included 742 CKD patients stages 3-5 not on dialysis from 39 centres in Spain). Methods: The OSERCE II study enrolled 742 subjects. Of these 612 had thoracolumbar xrays available for review. Xrays were reviewed by 3 musculoskeletal radiologists and vertebral fractures identified using Genant semi-quantitavie morphometry Avisual semiquantitative grading of vertebral fractures was done individually by three musculo-skeletal radiologists with more than 10 years experience. In cases of doubt they concurred on the location of the VF, generally due to transition anomalies.Our approach has been to consider the loss of fracture height equal to or greater than 20%. The mean age of the subjects was 66±12 years, about 1/3 were female, and 1/3 had diabetes. The mean eGFR by MDRD was 27±12 ml/min/1,73m2). Results: Vertebral fractures were identified in 110 (18%) subjects. Factors associated with fractures were phosphoremia (OR 0.719, 95% CI 0.532 to 0.972, P = 0.032, Ankle Brachial Index 3 and phosphorus, showed age (HR 1.074, 95% CI 1035-1114, p 3 (HR 2.487, 95% CI 1345-4598, P = 0.004) as independent predictors of mortality. Conclusions: About 20% of subjects in our study had VF. Factors associated with VF were age, low levels of phosphorus and peripheral vascular disease. The presence of VF is an independent risk factor for mortality in patients with CKD stages 3-5 not on dialysis. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis.