Prevalence of Bone Mineral Disorders in Hemodialysis Patients: A Prospective Observational Study from a Tertiary Care Hospital in South India

Abstract

: Background: Chronic kidney disease – mineral and bone disorder (CKD-MBD) is nearly universal among patients undergoing maintenance hemodialysis and contributes substantially to fracture risk and cardiovascular morbidity. Data on its prevalence and biochemical correlates from Indian dialysis populations remain limited. Methods: This prospective observational study enrolled 85 adult patients undergoing maintenance hemodialysis (>6 months) at Chinmaya Mission Hospital, Bengaluru. Bone mineral density (BMD) was assessed using Lumbar spine DEXA, and bone turnover was categorised using intact parathyroid hormone (iPTH). Serum calcium, phosphate, alkaline phosphatase, and vitamin D were measured. Associations were analysed using Chi-square/Fisher's exact tests (STATA v16.0); p<0.05 was considered significant. Results: Mean age skewed older, with 51.8% of participants aged ≥60 years, and 64.7% were male. Low BMD (osteopenia or osteoporosis) was present in 48.2% of patients (osteopenia 34.1%, osteoporosis 14.1%). Bone turnover by iPTH was heterogeneous (low turnover 33.0%, normal 38.8%, high 28.2%). Vitamin D deficiency (<10 ng/mL) and insufficiency (10 – 29 ng/mL) were highly prevalent (28.2% and 51.8% respectively). Serum phosphate showed a statistically significant association with BMD status (p=0.04), with hyperphosphatemia more frequent in patients with normal BMD. Vitamin D, serum calcium, alkaline phosphatase, dialysis duration, and comorbidities showed no significant association with BMD or bone turnover status (all p>0.05). Conclusion: Nearly half of hemodialysis patients in this cohort had reduced bone mineral density, with disordered phosphate metabolism emerging as the dominant correlate. Routine biochemical and BMD surveillance, with a particular focus on phosphate control, is warranted in this high-risk population.