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Kidney Function During Ageing and its Association with Bone Mass, Fracture and Mortality

Malmgren, Linnea LU (2020) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract (Swedish)
Osteoporosis and osteoporosis related fractures are a major health care challenge both in Sweden and globally. The cost and suffering from osteoporosis are expected to increase since the population of elderly is increasing. Bone health can be affected by altered mineral homeostasis, which in its turn can be affected by reduced kidney function. However, the course of age-related decline in kidney function and its association to osteoporosis and
fracture in the very elderly need further investigation since longitudinal data are scarce. Therefore, this thesis has two main aims; 1) to investigate kidney function during ageing and 2) its association to bone health in a cohort of
elderly women.

Data was collected through the... (More)
Osteoporosis and osteoporosis related fractures are a major health care challenge both in Sweden and globally. The cost and suffering from osteoporosis are expected to increase since the population of elderly is increasing. Bone health can be affected by altered mineral homeostasis, which in its turn can be affected by reduced kidney function. However, the course of age-related decline in kidney function and its association to osteoporosis and
fracture in the very elderly need further investigation since longitudinal data are scarce. Therefore, this thesis has two main aims; 1) to investigate kidney function during ageing and 2) its association to bone health in a cohort of
elderly women.

Data was collected through the Malmö Osteoporosis Prospective Risk Assessment (OPRA) cohort, a prospective cohort of 1044 community dwelling women, all aged 75 and followed for ten years with reinvestigations at age 80
and 85. Data on BMD, fracture and blood biochemistry was available at all three time points.

Estimated kidney function greatly depends on which marker and study equation is used. The discrepancies are to such an extent that could affect whether a person is diagnosed with chronic kidney disease (CKD) or not, of particular importance in the elderly. Only women with the worst kidney function, corresponding to CKD stage 3b-5, had continuously increased mortality risk. This indicates that an age-dependent CKD definition would be of value
in elderly women.

Kidney function in elderly women was associated with markers of mineral homeostasis, bone loss and BMD, but the effect size was relatively small compared to other risk factors. Also, fracture risk was increased only in women
with mild-moderate reduction of kidney function (CKD stage 3a) and not in women with the worst kidney function (CKD stage 3b-5). Low BMD was associated with increased fracture risk independent of kidney function. Having
both reduced kidney function and osteoporosis could present an additional risk increase.

In conclusion, estimated kidney function in elderly women greatly depends on method of estimation and the results advocate for an age-adapted CKD definition. Maintaining adequate kidney function is important for
maintaining bone health, although in old age it is probable that the effect size of any single specific risk factor is smaller compared with younger individuals. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • docent Barany, Peter, Karolinska universitetssjukhuset, Stockholm, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Geriatrik, Njurfunktion, ortopedi, Fraktur, Benmassa, Åldrande
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2020:18
pages
89 pages
publisher
Lund University, Faculty of Medicine
defense location
Ortopedens föreläsningssal, Inga Marie Nilssons gata 22, Skånes Universitetssjukhus i Malmö
defense date
2020-02-14 09:00:00
ISSN
1652-8220
ISBN
978-91-7619-878-0
language
English
LU publication?
yes
id
cadc08e8-7f5b-4f8b-9470-b4c71727f459
date added to LUP
2020-01-23 15:05:03
date last changed
2020-02-06 08:53:35
@phdthesis{cadc08e8-7f5b-4f8b-9470-b4c71727f459,
  abstract     = {Osteoporosis and osteoporosis related fractures are a major health care challenge both in Sweden and globally. The cost and suffering from osteoporosis are expected to increase since the population of elderly is increasing. Bone health can be affected by altered mineral homeostasis, which in its turn can be affected by reduced kidney function. However, the course of age-related decline in kidney function and its association to osteoporosis and<br/>fracture in the very elderly need further investigation since longitudinal data are scarce. Therefore, this thesis has two main aims; 1) to investigate kidney function during ageing and 2) its association to bone health in a cohort of<br/>elderly women.<br/><br/>Data was collected through the Malmö Osteoporosis Prospective Risk Assessment (OPRA) cohort, a prospective cohort of 1044 community dwelling women, all aged 75 and followed for ten years with reinvestigations at age 80<br/>and 85. Data on BMD, fracture and blood biochemistry was available at all three time points.<br/><br/>Estimated kidney function greatly depends on which marker and study equation is used. The discrepancies are to such an extent that could affect whether a person is diagnosed with chronic kidney disease (CKD) or not, of particular importance in the elderly. Only women with the worst kidney function, corresponding to CKD stage 3b-5, had continuously increased mortality risk. This indicates that an age-dependent CKD definition would be of value<br/>in elderly women.<br/><br/>Kidney function in elderly women was associated with markers of mineral homeostasis, bone loss and BMD, but the effect size was relatively small compared to other risk factors. Also, fracture risk was increased only in women<br/>with mild-moderate reduction of kidney function (CKD stage 3a) and not in women with the worst kidney function (CKD stage 3b-5). Low BMD was associated with increased fracture risk independent of kidney function. Having<br/>both reduced kidney function and osteoporosis could present an additional risk increase.<br/><br/>In conclusion, estimated kidney function in elderly women greatly depends on method of estimation and the results advocate for an age-adapted CKD definition. Maintaining adequate kidney function is important for<br/>maintaining bone health, although in old age it is probable that the effect size of any single specific risk factor is smaller compared with younger individuals.},
  author       = {Malmgren, Linnea},
  isbn         = {978-91-7619-878-0},
  issn         = {1652-8220},
  language     = {eng},
  number       = {2020:18},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Kidney Function During Ageing and its Association with Bone Mass, Fracture and Mortality},
  url          = {https://lup.lub.lu.se/search/ws/files/75419671/e_nailing_ex_Linnea.pdf},
  year         = {2020},
}