Associated factors of osteoporosis and vascular calcification in patients awaiting kidney transplantation

Int Urol Nephrol. 2023 Dec;55(12):3217-3224. doi: 10.1007/s11255-023-03606-0. Epub 2023 Apr 24.


Introduction: Pretransplant osteoporosis and vascular calcification probably increase the risk of fractures and cardiovascular events after kidney transplantation. In the present study, we investigated the related risk factors of osteoporosis and vascular calcification among end-stage renal disease (ESRD) patients awaiting kidney transplantation.

Methods: A total of 221 ESRD patients (age, 43.4 ± 14.3 years; 125 males and 96 females; median dialysis duration, 61.0 m) awaiting kidney transplantation were enrolled in this cross-sectional study. Serum levels of bone turnover markers and intact parathyroid hormone (iPTH) were analyzed from fasting morning blood samples. Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD). Vascular calcification was evaluated by lateral abdominal radiography and plain radiographic films of the pelvis and hands.

Results: The osteoporosis prevalence was 27.6% in this cohort of kidney transplantation candidates, and the prevalence of vascular calcification was 51.1%. The related factors for osteoporosis and vascular calcification were similar and included older age, longer dialysis duration, parathyroid hyperplasia, and higher levels of iPTH and bone turnover markers. In the multivariable regression model, age and iPTH were independent risk predictors of both vascular calcification and osteoporosis. There were strong, positive correlations between iPTH and all bone turnover markers. The moderate and severe hyperparathyroidism (iPTH 600-1499 pg/ml and iPTH 1500 pg/ml) were related to reduced serum albumin and hemoglobin levels.

Conclusion: The involvement of high iPTH levels in vascular calcification, osteoporosis, and malnutrition indicated the need of treating hyperparathyroidism early in patients awaiting kidney transplantation. Prospective studies are needed to further examine the utility of bone turnover markers.

Keywords: Bone turnover markers; Osteoporosis; Secondary hyperparathyroidism; Vascular calcification.

MeSH terms

  • Adult
  • Bone Density
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hyperparathyroidism*
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / therapy
  • Kidney Transplantation* / adverse effects
  • Male
  • Middle Aged
  • Osteoporosis* / complications
  • Osteoporosis* / etiology
  • Parathyroid Hormone
  • Vascular Calcification* / diagnostic imaging
  • Vascular Calcification* / epidemiology
  • Vascular Calcification* / etiology


  • Parathyroid Hormone