RESULTS METHODS INTRODUCTION and AIMS

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1 RESULTS METHODS INTRODUCTION and AIMS
VERTEBRAL FRACTURES, VASCULAR CALCIFICATIONS AND MORTALITY IN DIALYSIS PATIENTS. THE EVERFRACT STUDY Maria Fusaro 1, M.D., Ph.D., Giovanni Tripepi2, M.S.C ., Marianna Noale 1, M.S.C.,., Angela D’Angelo3, M.D., Davide Miozzo3,M.D., Rosalba Cristofaro3, and Maurizio Gallieni4, M.D., for the VF (Vertebral Fracture) and VC (Vascular Calcification) Study Group p 1CNR Aging Section, Institute of Neuroscience, Padua, Italy;2CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases Hypertension of Reggio Calabria,Reggio Calabria , Italy; 3 Nephrology Unit, University of Padua, Italy; 4Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy METHODS INTRODUCTION and AIMS At least two different approaches are suitable for identifying vertebral fractures: one is a semiquantitative visual method, proposed by Genant [1], which involves an expert radiologist visually identifying the fractures and classifying them, according to the extent of the reduction in the dimension of the vertebral body, as mild (20–25%), moderate (25–40%) or severe (>40%), as illustrated in Fig 1. The other approach is a quantitative morphometric method. In particular, vertebral morphometry (VM) involves the manual or computerized measurement of the anterior, central and posterior dimensions of the dorsal and lumbar vertebral bodies (T4-L5) of the spine using conventional radiological apparatus (MRX: morphometric X-ray radiography) or densitometric apparatus (MXA: morphometric X-ray absorptiometry). Fig.1 . Vascular calcifications (VC) may be associated with low bone mineral density. Aim: We evaluated the prevalence of VF, VC and mortality in hemodialysis patients. 18 Italian dialysis centers, 387 hemodialysis (HD) patients (143 F, 37% ; 244 M, 63%), mean age 64±14 (SD) years, median dialytic age 49 months, BMI 25± 4 Kg/m2. VF were evaluated with MorphoXpress, a tool for computerized analysis of scanned L-L vertebral X-rays. Reduction of >20% of vertebral body height was considered a VF. Types of vertebral deformity differ when the reduction concerns the anterior, central or posterior dimension of the vertebra, respectively: wedge, biconcave or crush fractures [1] (Fig 1). Using the same X-ray we evaluated the prevalence of vascular calcifications (VC) of the abdominal aorta, and of the iliac arteries (absence or presence). VC were quantified by measuring the length of calcific deposits along the arteries (mild cm, moderate cm and severe >10 cm) [2]. RESULTS We found VF in 55% of patients (Fig.2), were associated with age (p<0,001), and lower serum BGP (p<0,01). Prevalence of VC was 81% in the aorta and 55% in the iliac arteries (Fig. 3). Patients with VF are more likely to present VC (VF and AoVC p=0,014 – VF and IaVC p<0,001) ( Fig. 4 ). AoVC were significantly associated with increased C reactive protein (p=0,012 and with reduced BGP (p<0,001). IaVC were also associated with BGP (p=0,01). 77 (19,9%) patients died during follow-up (2,7±0,1 years). Patients with severe AoVC had lower survival probability (log rank test p<0,0001) (Fig 5). Median alkaline phosphatase (ALP) and (CRP) were significantly higher in non-survivors, while median MGP was significantly lower. ALP and CRP were predictors of mortality (HR 1,03, p<0,0001; HR 1,05, p=0,0056; respectively). Fig.1 Types of vertebral fractures Fig. 3 Prevalence VC in HD patients Fig. 2 Prevalence VF in HD patients P=0.014 % Fig 5. Aortic calcification and mortality Fig. 4 Association between VF and VC in HD patients CONCLUSIONS VF and VC showed high prevalence in HD patients. VF and VC are associated. Increased CPR and ALP are both predictors of mortality. REFERENCES: Participating centers: Adria (Dott. Stoppa F; Dott.ssa Bernardi AM); Bassano del Grappa (Dott.ssa Pellanda V; Dott. Dell’Aquila R); Belluno (Dott. Tarroni G; Dott. De Paoli Vitali); Bolzano (Dott. Corradini R; Dott. Avolio M; Dott.Giacon B); Castelfranco V.to (Dott. Ferraro A; Dott. De Luca M); Dolo (Dott. Lucatello S; Dott.ssa Meneghel G); Feltre (Dott. Vianello A; Dott. Antonucci F); Firenze (Dott.ssa Grimaldi C; Dott. Mannarino A); Lodi (Dott. Barbisoni F; Dott. Elli A); Mestre (Dott. Morachiello P; Dott. Feriani M); Padova (Dott.ssa Rebeshini M; Dott. Naso A); Piove di Sacco-Chioggia (Dott.ssa Spinello M; Dott. Urso M); Rovigo (Dott.ssa Pati T; Dott. Gemelli A; Dott.ssa Bernardi AM); Schio (Dott.ssa Magonara FM; Dott. Axia M); Sesto SG (Dott. Ciurlino D; Dott. Bertoli S); Trento (Dott. Pica A; Dott.ssa Venturelli C; Dott. Brunori G); Treviso (Dott.ssa Puggia R; Dott.ssa Caberlotto A; Dott.ssa Mastrosimone S; Dott. Cascone C); Voghera (Dott.ssa Foschi A; Dott Milanesi F) 1.Genant HK, Wu CY, Van Kuijk C et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8: 1137–1148 2. Witterman JC, Grobbee DE, Valkenburg HA et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet 343: , 1994. Corresponding Author Maria Fusaro, M.D., Ph.D. CNR Aging Section, Institute of Neuroscience, Padua, Italy Via Giustiniani, 2, Padova, Italy. Telephone: FAX: