Bone mineral density abnormalities in end stage chronic kidney disease patients in Pakistan

To determine the proportion of CKD patients with osteopenia and osteoporosis in Pakistan. A prospective cross-sectional observational study, reported according to the STROBE guideline, was conducted among CKD stage-5 patients undergoing treatment and dialysis at three tertiary care hospitals in Pakistan. The sample size was calculated using Epi Info StatCalc. Demographic, clinical, laboratory, medication-related, and BMD data were collected using standardized data collection forms. Vitamin D levels and routine biochemical parameters were assessed, and BMD was measured using DXA at the lumbar spine site. Multivariable binary logistic regression was performed to identify predictors of BMD outcomes. A total of 412 CKD stage-5 patients were included in the study. The mean age of participants was 46.98 ± 11.87 years, and 63.1% were male. The proportion of patients with osteopenia and osteoporosis was 41.0% (95% CI: 36.3%–45.8%) and 26.5% (95% CI: 22.5%–31.0%), respectively. Significant associations were observed between BMD abnormalities and age, vitamin D status, calcium levels, phosphate levels, and dialysis-related variables ( p < 0.05). Multivariable regression analysis demonstrated that relatively higher eGFR within this stage-5 CKD cohort and higher vitamin D levels were independently associated with favorable BMD outcomes. Osteopenia and osteoporosis were observed in a high proportion of CKD stage-5 patients and are strongly associated with disturbances in mineral metabolism and vitamin D status. Regular bone health assessment and appropriate management of CKD-related mineral and bone disorders may help improve skeletal outcomes in this population.