[Fragility Fractures in Hemodialysis Patients. Frailty and fragility fractures among dialysis patients.]

According to the current status of chronic dialysis therapy in Japan 2016, the average age at the time of dialysis initiation is 68.57 years for males and 71.19 years for females, which has been rising continuously. Frailty is a geriatric syndrome that is frequently seen in the elderly. It is known that frailty among dialysis patients are more common than the general population of the same age, and that frailty is associated with life prognosis. As eGFR decreases, BMD decreases and fracture risk increase, and dialysis patients are at the highest risk of fracture in CKD patients. Various factors such as frailty, sarcopenia, PEW(protein-energy wasting), dynapenia, uremic osteoporosis, diabetes, AGEs(advanced glycation end products), oxidative stress, falls are involved in the increased risk of fracture in dialysis patients, and consequently, fragile fractures occur frequently in dialysis patients. Fragile fracture is a common complication in dialysis patients, and it is reported that the hospitalization for fracture, and the subsequent course is associated with poor prognosis. In diabetes, bone quality declines without loss of BMD, so the conventional DXA method may be insufficient in predicting fracture risk among dialysis patients, and the evaluation method using HR-pQCT or FRAXR may be useful. It has been reported that bisphosphonate is an established therapy in patients with primary osteoporosis, but many bisphosphonates cannot be used at eGFR of less than 30 mL/min per 1.73 m2. Bisphosphonate-related adverse effects such as accumulation, ossification, osteomalacia, ADB(adynamic bone), and jaw bone necrosis were reported, there are few reports of usefulness in CKD patients. Denosumab administration trial results for women with osteoporosis in dialysis patients have been waited(NCT 01464931). In this article, we outline the relation, diagnosis, and treatment of fragile fractures and frailty in dialysis patients.