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Active Vitamin D Use and Fractures in Hemodialysis Patients : Results from the International DOPPS

Komaba, Hirotaka ; Zhao, Junhui ; Karaboyas, Angelo ; Yamamoto, Suguru ; Dasgupta, Indranil ; Hassan, Mohamed ; Zuo, Li ; Christensson, Anders LU ; Combe, Christian and Robinson, Bruce M. , et al. (2023) In Journal of Bone and Mineral Research 38(11). p.1577-1585
Abstract

Active vitamin D is commonly used to control secondary hyperparathyroidism in dialysis patients, but it is unknown whether active vitamin D directly improves bone strength, independently of its ability to suppress parathyroid hormone (PTH). We analyzed the association between the prescription of active vitamin D and incidence of any fracture and hip fracture in 41,677 in-center hemodialysis patients from 21 countries in phases 3 to 6 (2005 to 2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS). We used Cox regression, adjusted for PTH and other potential confounders, and used a per-protocol approach to censor patients at treatment switch during follow-up. We also used a facility preference approach to minimize confounding... (More)

Active vitamin D is commonly used to control secondary hyperparathyroidism in dialysis patients, but it is unknown whether active vitamin D directly improves bone strength, independently of its ability to suppress parathyroid hormone (PTH). We analyzed the association between the prescription of active vitamin D and incidence of any fracture and hip fracture in 41,677 in-center hemodialysis patients from 21 countries in phases 3 to 6 (2005 to 2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS). We used Cox regression, adjusted for PTH and other potential confounders, and used a per-protocol approach to censor patients at treatment switch during follow-up. We also used a facility preference approach to minimize confounding by indication. Overall, 55% of patients were prescribed active vitamin D at study enrollment. Event rates (per patient-year) were 0.024 for any fracture and 0.010 for hip fracture. The adjusted hazard ratio (95% confidence interval) comparing patients prescribed versus not prescribed active vitamin D was 1.02 (0.90 to 1.17) for any fracture and 1.00 (0.81 to 1.23) for hip fracture. In the facility preference approach, there was no difference in fracture rate between facilities with higher versus lower active vitamin D prescriptions. Thus, our results do not suggest a PTH-independent benefit of active vitamin D in fracture prevention and support the current KDIGO guideline suggesting the use of active vitamin D only in subjects with elevated or rising PTH. Further research is needed to determine the role of active vitamin D beyond PTH control.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ACTIVE VITAMIN D, BONE METABOLISM, FRACTURE, HEMODIALYSIS, PARATHYROID HORMONE, SECONDARY HYPERPARATHYROIDISM
in
Journal of Bone and Mineral Research
volume
38
issue
11
pages
9 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:37718534
  • scopus:85173447411
ISSN
0884-0431
DOI
10.1002/jbmr.4913
language
English
LU publication?
yes
id
8b00f14a-5b86-4e8d-aa4e-21a34af4a9d9
date added to LUP
2023-12-20 11:03:56
date last changed
2024-04-18 20:42:34
@article{8b00f14a-5b86-4e8d-aa4e-21a34af4a9d9,
  abstract     = {{<p>Active vitamin D is commonly used to control secondary hyperparathyroidism in dialysis patients, but it is unknown whether active vitamin D directly improves bone strength, independently of its ability to suppress parathyroid hormone (PTH). We analyzed the association between the prescription of active vitamin D and incidence of any fracture and hip fracture in 41,677 in-center hemodialysis patients from 21 countries in phases 3 to 6 (2005 to 2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS). We used Cox regression, adjusted for PTH and other potential confounders, and used a per-protocol approach to censor patients at treatment switch during follow-up. We also used a facility preference approach to minimize confounding by indication. Overall, 55% of patients were prescribed active vitamin D at study enrollment. Event rates (per patient-year) were 0.024 for any fracture and 0.010 for hip fracture. The adjusted hazard ratio (95% confidence interval) comparing patients prescribed versus not prescribed active vitamin D was 1.02 (0.90 to 1.17) for any fracture and 1.00 (0.81 to 1.23) for hip fracture. In the facility preference approach, there was no difference in fracture rate between facilities with higher versus lower active vitamin D prescriptions. Thus, our results do not suggest a PTH-independent benefit of active vitamin D in fracture prevention and support the current KDIGO guideline suggesting the use of active vitamin D only in subjects with elevated or rising PTH. Further research is needed to determine the role of active vitamin D beyond PTH control.</p>}},
  author       = {{Komaba, Hirotaka and Zhao, Junhui and Karaboyas, Angelo and Yamamoto, Suguru and Dasgupta, Indranil and Hassan, Mohamed and Zuo, Li and Christensson, Anders and Combe, Christian and Robinson, Bruce M. and Fukagawa, Masafumi}},
  issn         = {{0884-0431}},
  keywords     = {{ACTIVE VITAMIN D; BONE METABOLISM; FRACTURE; HEMODIALYSIS; PARATHYROID HORMONE; SECONDARY HYPERPARATHYROIDISM}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1577--1585}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Bone and Mineral Research}},
  title        = {{Active Vitamin D Use and Fractures in Hemodialysis Patients : Results from the International DOPPS}},
  url          = {{http://dx.doi.org/10.1002/jbmr.4913}},
  doi          = {{10.1002/jbmr.4913}},
  volume       = {{38}},
  year         = {{2023}},
}