J Gen Intern Med. 2026 May 6. doi: 10.1007/s11606-026-10398-3. Online ahead of print.
ABSTRACT
BACKGROUND: End-stage renal disease (ESRD) requiring hemodialysis (HD) disproportionately affects older adults, who face increased risks of falls and fractures due to age-related changes, renal osteodystrophy, comorbidities and dialysis-related factors. Although bone abnormalities and fall risk have often been examined separately in patients with ESRD, few studies have evaluated vertebral compression fractures (VCF) in older HD patients while concurrently assessing skeletal, functional and geriatric risk factors. The role of Comprehensive Geriatric Assessment (CGA) in identifying multidimensional risk factors in this context remains underexplored.
OBJECTIVE: To investigate associations between bone mass, falls and VCF in older adults undergoing HD, and evaluate the utility of CGA in identifying risk factors and informing care strategies.
PARTICIPANTS: This cross-sectional study enrolled 50 older adults (≥ 65 years; mean age 67.8 (3.2), range 65-76) with ESRD on maintenance HD. Participants had multiple comorbidities, typical of this population, including anemia, cardiovascular disease and chronic liver disease.
MAIN MEASURES: Bone mineral density was assessed using dual-energy X-ray absorptiometry. Falls, VCF, comorbidities, and medication use were documented via interviews and medical records. CGA included assessments of activities of daily living (ADLs), mobility, cognition, depression, nutrition and social support. FRAX scores and biochemical markers (parathyroid hormone [PTH], bone-specific alkaline phosphatase [ALP]) were analyzed.
RESULTS: Falls occurred in 28% of participants, significantly associated with prior fall history (p < 0.001), advanced age (p = 0.011), anemia (p = 0.040), chronic liver disease (p = 0.044), reduced mobility (p = 0.037), depression (p = 0.01), impaired ADLs (p = 0.037) and poor nutrition (p = 0.032). VCF were present in 14%, associated with earlier menopausal age, back pain, elevated ALP and higher FRAX scores. Osteoporosis was most prevalent at the distal radius (46%). Hip T-scores were lower in the VCF group (p = 0.003). PTH and ALP were significantly higher in VCF patients (p = 0.003), indicating impaired bone turnover.
CONCLUSION: Older adults on HD face a substantial burden of falls and vertebral fractures due to overlapping functional, metabolic and psychosocial factors. CGA effectively identified multidimensional risks, underscoring the need for integrated preventive strategies.
PMID:42091796 | DOI:10.1007/s11606-026-10398-3