Osteoporosis Screening Often Missed in Patients With End-Stage Renal Disease

Pam Harrison

November 15, 2019

WASHINGTON — Women with end-stage renal disease (ESRD) on maintenance hemodialysis are rarely screened for osteoporosis, despite the fact that they are at heightened risk for a variety of bone diseases compared with the general population, research here indicates.

"The question we had was, does preventive care happen in these patients because they are already spending so much time in [the] hospital and the assumption is that if there was anything that needed to be done, it will be done during dialysis by the nephrologist?" Amir Kazory, MD, told Medscape Medical News.

"To our surprise, almost all of these patients had a primary care physician, although this might be because the two dialysis units they are being treated at are affiliated with an academic center — so it could be very different elsewhere," he added.

"But while we found that breast and cervical cancer screening rates were actually higher in these patients than they are in the general population, screening rates for osteoporosis were very low, so our study identifies osteoporosis screening as an opportunity to improve preventive care for women with end-stage renal disease treated with hemodialysis," concluded Kazory, professor of medicine in the Division of Nephrology, Hypertension & Renal Transplantation at the University of Florida in Gainesville.

The study was presented here during Kidney Week 2019: American Society of Nephrology Annual Meeting.

Less Than 20% of Women With ESRD Screened for Osteoporosis

The aim of the study was to explore age-appropriate preventive care for women with ESRD receiving maintenance hemodialysis.

A total of 132 hemodialysis patients, half of whom were female, were interviewed to determine the type of healthcare providers they had, as well as the number of preventive services patients had taken advantage of.

The average age of the group was 60 years and almost 96% of them reported having a primary care practitioner.

Out of the group surveyed, 35 (81.4%) of 43 patients reported being up-to-date on breast cancer screening, as Kazory pointed out.

Three quarters (33 of 44) of the patients noted that they were up-to-date on screening for cervical cancer.

However, only 4 (16.7%) of 24 eligible patients reported that they had undergone recent screening for osteoporosis, Kazory noted.

This is even lower than osteoporosis screening in the general population (25%).

Interestingly, having a primary care provider was associated with a trend toward higher adherence with preventive care measures, although not significantly so.

As Kazory pointed out, it has been argued that physicians shouldn't bother to look for osteoporosis in patients with ESRD, as they are at risk for various kinds of bone disease, osteoporosis being only one of them.

This is because the kidneys have a key role in calcium and phosphorous homeostasis, "so when patients do not have kidney function, they are very prone to develop diseases related to calcium and phosphorous, including osteoporosis," he explained.

Perhaps in some of those at risk for osteoporosis, the expected survival time may not be long enough to justify screening and intervening with active therapy, Kazory acknowledged.

On the other hand, many of these patients develop bone diseases at a much younger age than someone in the general population who does not have ESRD, "so there is definitely room for treatment in many of these patients," he explained.

Osteoporosis Presents Differently in Patients With ESRD

Kazory also emphasized that osteoporosis may present very differently in an ESRD population, making it difficult to both diagnose and treat.

For example, bisphosphonates are contraindicated in patients with ESRD, so treatment options can be limited and nephrologists often have to rely on tools used to maintain calcium and phosphorous homeostasis to help control bone disease in this patient population.

"The bottom line is that osteoporosis is hard to pick up and hard to manage in ESRD patients, so it is often overlooked," he underscored.

"Future studies are needed," Kazory stressed, "to identify patient and provider characteristics associated with higher likelihood of adherence to age-appropriate preventive care for female patients with ESRD."

Kazory has disclosed no relevant financial relationships.

Kidney Week 2019: American Society of Nephrology Annual Meeting: Abstract TH-PO728. Presented November 7, 2019.

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