Introduction: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are characterized by generalized vascular calcification (VC) and impaired bone health. We aimed to investigate the relationship between VC and bone mineral density (BMD) in chronic hemodialysis patients. Methods: A cross-sectional study included 40 chronic hemodialysis patients for at least 6 months. For the assessment of VC, abdominal aorta lateral lumbar X-rays were used, and for the analysis of bone mineral density, dual-energy X-ray absorptiometry (DXA) at the lumbar spine (LS) and femoral neck (FN) was provided. Results: Forty patients were included; the average age was 59 ± 16 years, 47% were women, and the median of hemodialysis duration was 54 months. The prevalence of AAC was 57.5%; and the median AAC score was 3 [0.10]. The prevalence of osteoporosis at the lumbar spine was 27.5%, while at the femoral neck, it was 32.5%. The mean BMD at the lumbar spine was 0.999 ± 0.213; and at the femoral neck, it was 0.814 ± 0.239. In the correlation analysis, there was a significant association between AAC and BMD; ACC was inversely correlated with BMD of the spine (r = -0.368, p = 0.019) and femoral neck (r = -0.578, p ＜ 0.001). In linear regression analysis, with AAC as the dependent variable, there was a statistically significant negative relationship with BMD of the spine (p = 0.024), and BMD of the femoral neck (p = 0.002). Conclusion: Our study demonstrated that the presence of CV reduces BMD in hemodialysis patients; this implies the need for early diagnosis and optimal management of CKD-MBD. We believe that the results of our study will help in the planning of future research, as they also confirm the existence of the vascular-bone axis.
Cite this paper
Errihani, M. , Hassani, K. , Sobhi, A. , Benbria, S. , Zajjari, Y. and Elkabbaj, D. (2025). Association between Vascular Calcification and Bone Mineral Density in Chronic Hemodialysis Patients: A Single Moroccan Center Experience. Open Access Library Journal, 12, e2842. doi: http://dx.doi.org/10.4236/oalib.1112842.
Collins, A.J. (2003) Cardiovascular Mortality in End-Stage Renal Disease. The American Journal of the Medical Sciences, 325, 163-167. https://doi.org/10.1097/00000441-200304000-00002
Foley, R.N., Murray, A.M., Li, S., Herzog, C.A., McBean, A.M., Eggers, P.W., et al. (2005) Chronic Kidney Disease and the Risk for Cardiovascular Disease, Renal Replacement, and Death in the United States Medicare Population, 1998 to 1999. Journal of the American Society of Nephrology, 16, 489-495. https://doi.org/10.1681/asn.2004030203
Goodman, W.G., Goldin, J., Kuizon, B.D., Yoon, C., Gales, B., Sider, D., et al. (2000) Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing Dialysis. New England Journal of Medicine, 342, 1478-1483. https://doi.org/10.1056/nejm200005183422003
von der Recke, P., Hansen, M.A. and Hassager, C. (1999) The Association between Low Bone Mass at the Menopause and Cardiovascular Mortality. The American Journal of Medicine, 106, 273-278. https://doi.org/10.1016/s0002-9343(99)00028-5
Tankó, L.B., Christiansen, C., Cox, D.A., Geiger, M.J., McNabb, M.A. and Cummings, S.R. (2005) Relationship between Osteoporosis and Cardiovascular Disease in Postmenopausal Women. Journal of Bone and Mineral Research, 20, 1912-1920. https://doi.org/10.1359/jbmr.050711
Aoki, A., Kojima, F., Uchida, K., Tanaka, Y. and Nitta, K. (2009) Associations between Vascular Calcification, Arterial Stiffness and Bone Mineral Density in Chronic Hemodialysis Patients. Geriatrics & Geron-tology International, 9, 246-252. https://doi.org/10.1111/j.1447-0594.2009.00528.x
Kado, D.M., Browner, W.S., Blackwell, T., Gore, R. and Cummings, S.R. (2000) Rate of Bone Loss Is Associated with Mortality in Older Women: A Prospective Study. Journal of Bone and Mineral Research, 15, 1974-1980. https://doi.org/10.1359/jbmr.2000.15.10.1974
Elias, R.M., Dalboni, M.A., Coe-lho, A.C.E. and Moysés, R.M.A. (2018) CKD-MBD: From the Pathogenesis to the Identification and Development of Potential Novel Therapeutic Targets. Current Osteoporosis Reports, 16, 693-702. https://doi.org/10.1007/s11914-018-0486-0
(2017) KDIGO 2017 Clinical Practice Guideline: Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney International Supplements, 7, 1-59. https://kdigo.org/wp-content/uploads/2017/02/2017-KDIGO-CKD-MBD-GL-Update.pdf
Looker, A.C., Melton, L.J., Harris, T.B., Borrud, L.G. and Shepherd, J.A. (2020) Prevalence and Trends in Low Femur Bone Density among Older US Adults: NHANES 2005-2006 Compared with NHANES III. Journal of Bone and Mineral Research, 25, 64-71. https://doi.org/10.1359/jbmr.090706
Hyder, J.A., Allison, M.A., Criqui, M.H. and Wright, C.M. (2007) Association between Systemic Calcified Atherosclerosis and Bone Density. Calcified Tissue International, 80, 301-306. https://doi.org/10.1007/s00223-007-9004-6
Rukov, J.L., Gravesen, E., Mace, M.L., Hofman-Bang, J., Vinther, J., Andersen, C.B., et al. (2016) Effect of Chronic Uremia on the Transcriptional Profile of the Calcified Aorta Analyzed by RNA Sequencing. American Journal of Physiology-Renal Physiology, 310, F477-F491. https://doi.org/10.1152/ajprenal.00472.2015
Nordholm, A., Mace, M.L., Gravesen, E., Hofman-Bang, J., Morevati, M., Olgaard, K., et al. (2018) Klotho and Activin A in Kidney Injury: Plasma Klotho Is Maintained in Unilateral Obstruction despite No Upregulation of Klotho Biosynthesis in the Contralateral Kidney. American Journal of Physiology-Renal Physiology, 314, F753-F762. https://doi.org/10.1152/ajprenal.00528.2017
Laroche, M. and Delmotte, A. (2005) Increased Arterial Calcification in Paget’s Disease of Bone. Calcified Tissue International, 77, 129-133. https://doi.org/10.1007/s00223-005-0250-1
Orimo, H. (2010) The Mechanism of Mineralization and the Role of Alkaline Phos-phatase in Health and Disease. Journal of Nippon Medical School, 77, 4-12. https://doi.org/10.1272/jnms.77.4
Foley, R.N., Parfrey, P.S. and Sarnak, M.J. (1998) Epidemiology of Cardiovascular Disease in Chronic Renal Disease. Journal of the American Society of Nephrology, 9, S16-S23.
Hruska, K.A., Seifert, M. and Sugatani, T. (2015) Pathophysiology of the Chronic Kidney Disease-Mineral Bone Disorder. Current Opinion in Nephrology and Hypertension, 24, 303-309. https://doi.org/10.1097/mnh.0000000000000132
Nordholm, A., Mace, M.L., Gravesen, E., Olgaard, K. and Lewin, E. (2015) A Potential Kidney—Bone Axis Involved in the Rapid Minute-to-Minute Regulation of Plasma Ca2 . BMC Nephrology, 16, Article No. 29. https://doi.org/10.1186/s12882-015-0019-3
Mace, M.L., Gravesen, E., Nordholm, A., Egstrand, S., Morevati, M., Nielsen, C., et al. (2020) Chronic Kidney Disease-Induced Vascular Calcification Impairs Bone Metabolism. Journal of Bone and Min-eral Research, 36, 510-522. https://doi.org/10.1002/jbmr.4203
Uhlinova, J., Kuudeberg, A., Metsküla, K., Lember, M. and Ros-enberg, M. (2022) Significant Associations between Bone Mineral Density and Vascular Calcification in Patients with Different Stages of Chronic Kidney Disease. BMC Nephrology, 23, Article No. 327. https://doi.org/10.1186/s12882-022-02955-9
Salam, S., Gal-lagher, O., Gossiel, F., Paggiosi, M., Eastell, R. and Khwaja, A. (2021) Vascular Calcification Relationship to Vascular Biomarkers and Bone Metabolism in Advanced Chronic Kidney Disease. Bone, 143, Article ID: 115699. https://doi.org/10.1016/j.bone.2020.115699
Aleksova, J., Kurniawan, S., Vucak-Dzumhur, M., Kerr, P., Ebeling, P.R., Milat, F., et al. (2018) Aortic Vascular Calcification Is Inversely Associated with the Trabecular Bone Score in Patients Receiving Dialysis. Bone, 113, 118-123. https://doi.org/10.1016/j.bone.2018.05.014
Evenepoel, P., D’Haese, P., Bacchetta, J., et al. (2017) Bone Biopsy Practice Patterns across Europe: The European Renal Osteodystrophy Initiative—A Position Paper. Nephrology Dialysis Transplanta-tion, 32, 1608-1613.
