Prevalence, Fracture Risk, and Management Strategies for Osteoporosis in Patients Undergoing Maintenance Haemodialysis: A Prospective Observational Study

Background

Osteoporosis and increased fracture risk are important skeletal complications among patients with End-Stage Renal Disease (ESRD) undergoing maintenance haemodialysis. Early identification of low Bone Mineral Density (BMD), fracture risk assessment, and appropriate management may help optimize skeletal health.

Objectives

To assess the prevalence of osteoporosis, fracture risk, and management strategies among patients with Chronic Kidney Disease (CKD) progressing to ESRD and undergoing maintenance haemodialysis.

Materials and Methods

A six-month prospective observational study was conducted among 76 patients undergoing maintenance haemodialysis at a tertiary care teaching hospital. Demographic and clinical characteristics, medical history, biochemical parameters, BMD/T-scores, FRAX® scores, medications, and dietary interventions were recorded. BMD was categorized as normal, osteopenia, or osteoporosis based on available T-score reports. Ten-year probabilities of Major Osteoporotic Fracture (MOF) and hip fracture were assessed using FRAX®. Patients were followed for three months to evaluate changes in selected biochemical parameters and management strategies. Statistical analysis was performed using MedCalc, with p<0.05 considered statistically significant.

Results

Among 76 patients, 45 (59.2%) were male and 31 (40.8%) were female. Based on available T-score reports, 13 (17.1%) had osteoporosis, 53 (69.7%) osteopenia, and 10 (13.2%) normal BMD. Previous fracture was reported in 24 (31.6%) patients. Increased 10-year probability of MOF (≥20%) was observed in 29 (38.2%) patients, while increased hip fracture probability (≥3%) was observed in 21 (27.6%). Significant changes were observed in serum calcium, phosphorus, creatinine, Vitamin D, albumin, PTH, magnesium, and haemoglobin at three-month follow-up (p<0.001 for all). Dietary counselling (84.2%), calcium supplementation (76.3%), and Vitamin D supplementation (68.4%) were the most commonly documented management strategies. Denosumab, romosozumab, and raloxifene were prescribed to 14 (18.4%), 12 (15.8%), and 9 (11.8%) patients, respectively.

Conclusion

Low BMD was common among patients undergoing maintenance haemodialysis, with osteopenia predominating. A substantial proportion had previous fractures or increased FRAX-estimated fracture probabilities. Comprehensive assessment of BMD, fracture history, CKD-MBD parameters, and clinical risk factors, together with individualized nutritional and pharmacological management, may support skeletal health in this population.