Problems with "sugar" and "kidney" increase the risk of fractures by four times? Doctor: Chronic patients should check bone density as early as possible
Chronic diseases account for the majority of deaths, with diabetes and chronic kidney disease co-occurring effects
In Taiwan, chronic diseases are the largest among the top ten causes of death. For example, diabetes ranks fifth among the top ten causes of death. The number of direct deaths is about 11,450, increasing at an annual rate of about 25,000, and the overall number has exceeded 2 million. Although kidney disease (nephritis-nephritis syndrome and nephropathy) ranks ninth, it is the chronic disease with the highest medical expenditures in health insurance, with an annual cost of up to 40 billion.
Statistically, the prevalence of chronic kidney disease is as high as 11.9%, much higher than the average in other countries. The incidence of end-stage kidney disease has increased from 331 people per million people to 523 people per million people. Diabetic nephropathy caused by diabetes is the most common reason for kidney dialysis in Taiwan. It can be seen that the two major chronic diseases of “sugar” and “kidney” are like companion effects in Taiwan, an aging society, and their impact on the health of Taiwanese people is self-evident.
Are chronic patients more susceptible to osteoporosis? Doctors reveal 3 causes of chronic bone loss
However, in an aging society, the chronic disease that is most likely to directly cause death is “osteoporosis”, whose incidence rate increases with age and bone loss. Osteoporosis is more likely to occur in those over 50 years old. When patients with osteoporosis suffer a hip fracture, the mortality rate within one year is as high as 20%-24%. In patients with diabetes and chronic kidney disease, osteoporosis, which has no obvious early symptoms, is more likely to be a potentially fatal killer.
“Diabetes and chronic kidney disease can affect calcium absorption, cause neuropathy and circulatory system abnormalities, which are all reasons why patients have a higher risk of osteoporosis! Statistics show that the prevalence of osteoporosis in men and women over 50 years old is 23.9% and 38.3%, but as many as 38% of type 2 diabetics over 50 years old also have osteoporosis, and the proportion of women is as high as 45%!”
Wu Bingxun, who is a nephrologist and a diabetes health education specialist, is an attending physician at the Department of Nephrology at Chung Ho Memorial Hospital, Kaohsiung Medical University. He said that people with diabetes are more likely to suffer from bone loss due to high blood sugar, and chronic diseases can promote chronic inflammation. and neuropathy, all of which are adverse factors affecting bone health.
The mortality rate from kidney dialysis fracture is nearly 50%? Renal bone disease accelerates bone loss
Dr. Wu Bingxun pointed out that patients with chronic kidney disease are more likely to suffer from bone loss due to a “calcium-phosphorus imbalance” because their bodies are unable to excrete excess phosphorus. When kidney function is excessively low, it will also be accompanied by “metabolic acidosis”, causing bones to release more calcium and accelerating bone loss.
In addition, some patients with kidney diseases such as glomerulonephritis require long-term use of steroid drugs, which also makes chronic kidney patients more susceptible to osteoporosis.
“Patients with severe renal dysfunction, such as chronic kidney disease after stage 4 or 5, not only need dialysis (kidney dialysis) due to uremia, but also develop “renal bone lesions”, bone loss and fractures due to hyperparathyroidism. The risk is very high. According to health insurance data, once a dialysis patient is bedridden after a hip fracture, the one-year mortality rate is as high as 50%, which is 2-3 times higher than the general situation!”
Increased risk of slipping and falling! Pay attention to 1 warning sign about diabetes and kidney disease
Dr. Wu Bingxun said that the elderly and postmenopausal women lose bone density quickly. If factors such as diabetes and chronic kidney disease are combined, it is more likely that neuropathy affects muscle coordination, or small blood vessel disease causes blurred vision, leading to patient More likely to slip and fall. If bone density is not paid attention to or osteoporosis is treated in time, the chance of fracture will increase significantly.
“The risk of fractures in kidney dialysis patients is more than four times that of normal people, and the risk of fractures in stage 4 and 5 chronic kidney patients is also two times higher than that of patients with better kidney function. To avoid this, In fact, people with kidney disease and diabetes should be more aware of the warning signs of their own bone loss earlier!”
Dr. Wu Bingxun pointed out that the common warning signs of osteoporosis are “hunchback, shortness, and pain”, which means an obvious hunchback, a height that is more than 4 centimeters shorter than when younger, and frequent lower back pain. Patients usually are not aware of its existence, or they regard related signs as natural aging phenomena, which makes early osteoporosis difficult to detect. For example, if a wrist fracture occurs after a slight fall or collision, patients should be more vigilant.
Dr. Wu Bingxun emphasized that once osteoporosis occurs in the two major groups of people with diabetes and chronic kidney disease, the overall health risks cannot be underestimated. It is best to receive bone density-related examinations as early as possible. In particular, those who have bad living habits such as smoking, drinking alcohol, or taking steroids for a long time due to diseases are risk factors for faster bone loss. You should understand your own osteoporosis risk as early as possible.
What is a bone density test? Chronic kidney patients have 3 conditions to check quickly
“The current standard method for bone density testing is to use a DXA dual-energy X-ray absorptiometer to test. If the “T value” obtained by the test is between -1 and -2.5, it is considered to be osteodeficient; if the T value is less than -2.5, it will be considered osteoporosis. Diagnosed as osteoporosis. Due to the effects of high blood pressure and medications, the T value of patients with diabetes and kidney disease may have dropped to the warning level unknowingly. It is recommended to actively consult a doctor or use the FRAX questionnaire to assess the risk!”
Dr. Wu Bingxun said that the FRAX questionnaire is the most common fracture risk assessment. If you have chronic kidney disease, and the FRAX questionnaire shows that the risk percentage of osteoporotic fracture and hip fracture have reached the moderate risk or even “very high risk” range , or if the patient has hyperparathyroidism or needs to use steroids for a long time due to the disease, it is recommended to be evaluated by a physician for bone density testing. Especially in the FRAX risk assessment, patients with “high fracture risk” and “extremely high fracture risk” even need to consider whether they need to receive active treatment with osteoporosis drugs. For patients with extremely high fracture risk, it is recommended that priority be given to using bone-promoting drugs. The resulting drug increases bone density, which can then be used for long-term treatment with drugs that reduce bone loss.
The definition of “extremely high fracture risk” specifically mentioned is: osteoporosis fracture in the past 12 months, fracture despite receiving osteoporosis medication, multiple osteoporosis fractures, and occurrence of bone damage while taking medication. Patients with fractures (such as long-term steroid treatment), bone density T-scores lower than -3.0, patients with a high risk of falls or a history of injurious falls, patients with an extremely high risk of FRAX fractures (including osteoporotic fractures greater than 30%, hip joint fracture greater than 4.5%).
Renal and bone lesions are difficult to care for! Doctor: Treatment of osteoporosis is to reduce fracture mortality
“Early care of osteoporosis in patients with chronic kidney disease is actually to prevent a sharp increase in mortality after fractures. Not only do they have to face the risk of renal bone disease, but they also have to consider the use of various chronic disease drugs to avoid increasing the burden on the kidneys. Clinically, they are a group of people who are in great need of integrated care!”
Dr. Wu Bingxun gave an example. In the past, there was an 80-year-old stage 4 chronic kidney patient with chronic diseases such as high blood pressure. An X-ray revealed that several lumbar vertebrae had “collapsed.” After a bone density examination, it was found that he met the treatment standards. , concurrent osteoporosis treatment within the chronic kidney disease care system. The patient later fell unexpectedly, but no fractures occurred. It shows the important benefits of early detection of bone density and correct treatment for chronic patients.
Dr. Wu Bingxun also reminded that the Kidney Disease: Improving Global Outcomes (KDIGO), an international medical organization for chronic kidney disease, has reminded that whenever a nephrologist assesses a patient’s risk of fracture, it is recommended to prescribe a DXA bone density test. In the future, osteoporosis detection and treatment for chronic disease groups, including diabetes and kidney patients, should be directed towards early understanding of bone density to improve the quality of patient care.
Many people in the hospital are in the middle and late stages! Early detection of bone density for diabetes and chronic kidney disease
“The prevalence rate of chronic kidney disease abroad is about 6%-7%, while Taiwan’s data is about 11.9%. Not only is the prevalence rate higher than abroad, many patients who come to the hospital are already in the middle and late stages of kidney disease, or are suffering from diabetes. Renal lesions require kidney dialysis, and they are likely to be at high risk for osteoporotic fractures!”
Dr. Wu Bingxun said that if patients with diabetes and chronic kidney disease are diagnosed with osteoporosis, in addition to receiving an integrated kidney disease care plan early and receiving appropriate treatment, they should also quit smoking and excessive drinking, and increase exercise training to reduce bone loss. Quality loss. If patients with chronic kidney disease need to supplement calcium and vitamin D, they should consult a doctor to avoid affecting the body’s calcium absorption or causing abnormalities such as hypercalcemia.
Dr. Wu Bingxun emphasized that osteoporosis caused by low bone density may cause more serious sequelae in patients with chronic diseases such as diabetes and kidney patients, and even increase fracture mortality. In addition, the early symptoms of osteoporosis are not obvious and can only be known through bone density testing. People with chronic diseases are reminded to establish awareness of bone density testing and osteoporosis treatment in order to reduce fractures and irreversible damage caused by osteoporosis.
References:
Statistics Division of the Ministry of Health and Welfare of Taiwan: Statistics on causes of death in 2021
Yang Yining, Chen Ruiyi, Wang Xianyi, Zheng Gaozhen: “Diagnosis and Treatment of Diabetic Nephropathy”
Updated version of the Clinical Diagnosis and Treatment Guidelines for Chronic Kidney Disease in Taiwan_First Draft, A3-1 Epidemiology of Chronic Kidney Disease in Taiwan
Osteoporosis Society of Taiwan. Consensus and guidelines on the prevention and treatment of osteoporosis in adults in Taiwan. 2021 edition
Yuhao SI, et al. Iran J Public Health. 2019 Jul;48(7):1203-1214.
