Mineral Imbalance Closely Associated with Fracture Risk in CKD Patients: Study

A recent meta-analysis published in the BMC Nephrology revealed that abnormalities in key mineral metabolic markers significantly influence fracture risk in patients with chronic kidney disease (CKD). The study analyzed data from 32 independent studies and highlights the role of serum phosphate, calcium, intact parathyroid hormone (iPTH), and fibroblast growth factor 23 (FGF23) in bone health among CKD patients.

This study systematically reviewed data from sources including MEDLINE, Web of Science, EMBASE, and ClinicalTrials.gov to determine how these metabolic markers correlate with fractures in CKD patients. The pooled risk estimates were calculated using fixed-effects and random-effects models to ensure statistical accuracy.

This research found that both high and low levels of serum phosphate in hemodialysis (HD) patients were associated with an increased fracture risk. The patients with elevated phosphate levels had an 8% higher risk (RR = 1.08), while the patients with low phosphate levels had a 13% higher risk (RR = 1.13), both statistically significant.

Similarly, abnormal levels of iPTH were strongly linked to fracture risk in CKD patients. Both elevated and decreased iPTH levels significantly increased the likelihood of fractures, with risk ratios of 1.25 and 1.41, respectively. Another key finding was the impact of FGF23, a protein involved in phosphate metabolism. The patients with high FGF23 levels had a 32% higher risk of fractures (RR = 1.32), suggesting that disruptions in phosphate regulation play a crucial role in bone fragility.

In contrast, calcium levels showed a less definitive impact. While higher calcium levels appeared to reduce fracture risk, the result was not statistically significant (RR = 0.90). Also, low calcium levels indicated a potential increase in fracture risk (RR = 1.11) but also lacked strong statistical confirmation.

The study also evaluated the effectiveness of various treatments aimed at regulating mineral imbalances. Patients undergoing dialysis who were treated with phosphate binders experienced a 21% reduction in fracture risk (RR = 0.79). Cinacalcet which is used to manage iPTH levels, was associated with a 26% lower fracture risk (RR = 0.74). Vitamin D analogues, which help regulate calcium and phosphate metabolism, reduced fracture incidence by 18% (RR = 0.82).

However, these therapeutic benefits were primarily observed in hemodialysis patients. Non-dialysis CKD patients did not show a significant reduction in fracture risk despite treatment, indicating the need for tailored approaches for different CKD populations. Overall, the findings illuminate the importance of monitoring and managing mineral metabolic markers to reduce fracture risk in CKD patients.

Source:

Liu, Y., Zhang, Z. X., Fu, C. S., Ye, Z. B., Jin, H. M., & Yang, X. H. (2025). Association of aberrant mineral metabolic markers with fracture risk in chronic kidney disease: a comprehensive meta-analysis. BMC Nephrology, 26(1). https://doi.org/10.1186/s12882-025-03992-w