Hormone replacement therapy could help kidney dialysis patients

Men undergoing kidney dialysis may have lower testosterone and reproductive hormone levels, providing evidence as to why this group are more prone to bone fractures, a new Hudson Institute of Medical Research study has shown.

Dr Jasna Aleksova

The study, by Clinical Associate Professor Frances Milat and first author Dr Jasna Aleksova, suggests hormone replacement therapy could be used in clinical trials for people undergoing kidney dialysis.

The findings of the study, a collaboration between Hudson Institute, Monash Health, Monash University and Professor Grahame Elder from Westmead Hospital, have been published in the journal Kidney International.

The team examined 312 men who were on long-term dialysis therapy awaiting kidney, or pancreas and kidney, transplantation. The levels of testosterone, oestrogen and sex hormone-binding globulin (which binds to oestrogen and testosterone) were compared with bone mineral density and fractures.

They found that 42 per cent of the men had experienced a previous fracture, and that fracture risk was associated with sex hormone levels.

“We know that people with chronic kidney disease and those receiving dialysis are at a significantly increased risk of bone fractures,” Dr Aleksova, a consultant endocrinologist and PhD student, explains.

Reproductive hormones (testosterone and oestrogen) help keep bones strong and healthy. In the general population, when the levels of these hormones are low in the body, bones become fragile and are more likely to break or fracture.

“Despite this, the relationship between people with chronic kidney disease, bone fractures and sex hormones has not been established.”

Next steps

Dr Aleksova says the study sets the scene for larger studies and clinical trials to assess the potential benefits of hormone replacement therapies on bone health in patients with chronic kidney disease.

“If these trials prove successful, these patients will have improved bone quality which will ultimately lead to fewer fractures, improved quality of life and reduced mortality.”

CHRONIC KIDNEY DISEASE AND BONE FRACTURES FACTS

One in ten Australians have chronic kidney disease and the prevalence is increasing.
As the disease progresses, bone quality is compromised and, correspondingly, the risk of fractures significantly increases.
Patients with chronic kidney disease have up to a 60-fold greater risk of fracturing, and are more likely to die following a fracture, when compared to the general population.

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