# Prevalence and risk factors of CKD-associated osteoporosis in maintenance hemodialysis patients aged over 50 years: a cross-sectional study

## TL;DR

This study finds that nearly half of older dialysis patients have CKD-related osteoporosis, with women and those with low grip strength or low albumin levels being at higher risk.

## Contribution

The study identifies independent risk factors for CKD-associated osteoporosis in older hemodialysis patients, offering insights for targeted prevention.

## Key findings

- 42.3% of CKD G5D patients over 50 years had CKD-associated osteoporosis.
- Female gender, decreased grip strength, and lower albumin levels were significant risk factors.
- The findings suggest the need for enhanced screening and integrated management strategies for high-risk groups.

## Abstract

CKD-associated osteoporosis is a critical complication in Chronic Kidney Disease stage 5 on Dialysis(CKD G5D) patients, increasing fracture risk and mortality. However, its prevalence and risk factors in older adults undergoing CKD G5D are still poorly understood. This study aimed to investigate the prevalence and independent risk factors of CKD-associated osteoporosis in CKD G5D patients aged over 50 years in Hainan General hospital to guide targeted prevention and management strategies. This cross-sectional study enrolled 258 CKD G5D patients from Hainan General hospital (May 2023–October 2024). Bone mineral density at the lumbar spine, femoral neck, and total hip was measured using dual-energy X-ray absorptiometry. CKD-associated osteoporosis was defined as a T-score ≤ − 2.5 or the presence of a fragility fracture. Demographic data, body measurements, and laboratory results were collected and analyzed. Variable selection was performed using a combination of LASSO regression and univariate logistic regression, followed by multivariate logistic regression to identify independent risk factors. Among the participants, 109 (42.3%) were diagnosed with CKD-associated osteoporosis. Multivariable logistic regression analysis identified female (OR = 3.44, 95%CI: 1.77–6.80, P < 0.01), decreased grip strength (per 1 kg decrease) (OR = 1.05, 95%CI: 1.00-1.09, P < 0.05), and decreased albumin levels (per 1 g/L decrease) (OR = 1.11, 95%CI: 1.01–1.22, P = 0.03) as independent risk factors for CKD-associated osteoporosis. CKD-associated osteoporosis is highly prevalent in CKD G5D patients over 50 years old, especially in females with low grip strength and low albumin levels. This highlights the need for enhanced screening of high-risk groups and integrating muscle function training and nutritional interventions into CKD-associated osteoporosis management.

The online version contains supplementary material available at 10.1038/s41598-026-35136-x.