Journal of the Nephrology Society of Thailand · Feb 27, 2026
Risk Factors and Outcome of Decreased Bone Mineral Density in Chronic Kidney Disease Stages 5-5D Patients
By Adunyatam K, Srisuwarn P, Pathumarak A et al.
Background: Mineral and bone disorders in chronic kidney disease (CKD) involve disturbances in mineral metabolism and hormonal regulation that lead to bone loss, fractures, and increased mortality. While bone mineral density (BMD) testing does not directly assess bone turnover, the 2017 KDIGO guidelines recommend BMD testing in CKD stages G3a–G5D for those at risk of osteoporosis, given the growing evidence linking low BMD to adverse outcomes. However, data in advanced CKD remains limited.Methods: This retrospective study evaluated BMD in 189 patients with CKD stages 5-5D who underwent total hip, femoral neck, or lumbar spine BMD testing between 2011 and 2022, with an average follow-up of 51.2 months.Results: Multivariate analyses revealed that the presence of a lower T-score or osteoporosis at any skeletal site, as well as at each site separately, was associated with traditional risk factors, including older age, lower body mass index, and female sex. Biochemical markers, such as reduced serum calcium, elevated alkaline phosphatase, decreased total lymphocyte and platelet counts, as well as elevated mean corpuscular volume, were associated with reduced BMD. Patients with CKD stage 5D experienced greater BMD decline than those in stage 5. Osteoporosis at all skeletal sites predicted all-cause mortality.Conclusion: Reduced BMD and osteoporosis in advanced CKD were linked to traditional risk factors, disordered mineral metabolism, systemic inflammation, and nutritional deficiencies, and were predictors of mortality.