{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:29:16Z","timestamp":1762918156236,"version":"3.40.5"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>End-Stage Renal Disease (ESRD) is the ultimate result of chronic kidney disease (CKD). In Palestine, the prevalence of ESRD was 240.3 PMP which is comparable with the nearby countries. Accelerated bone loss among ESRD patients is attributed to abnormal bone turn over that leads to osteoporosis and osteopenia. The risk of fractures is increased four-fold in men and women on hemodialysis, which explains the importance of assessing the bone mineral density among these population. The goals of this study were to find the prevalence of osteoporosis in ESRD patients as determined by bone mineral density (BMD) at different sites and to determine whether BMD correlates with many other clinical parameters.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional study of 194 ESRD patients were recruited from the dialysis unit in An-Najah National University Hospital, Nablus, Palestine. The patients were on regular hemodialysis or peritoneal dialysis. BMD was measured at the lumbar spine and the hip using the dual-energy X-Ray absorptiometry (DEXA) and the value is expressed as T-score. The data were analyzed using SPSS, version 26. The relationship between BMD and the clinical and biochemical parameters among the ESRD patients was assessed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We found that 42.8% of ESRD patient had osteoporosis and 40.2% had osteopenia. There were significantly higher proportions of osteoporosis and osteopenia among patients &gt;60 years of age (p&lt;0.005). Patients with osteoporosis and osteopenia had significantly higher serum levels of PTH (792.9 and 469.7) (p&lt;0.05). BMD decreases as the duration of dialysis (39.0 months Vs. 56.8 months), (p&lt;0.05). We found no significant difference between patients on hemodialysis or peritoneal dialysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study showed that Palestinian patients with ESRD have low BMD at the hip and spine. The observed high serum level of PTH was associated with low BMD. Those patients should be closely monitored especially those with more than one risk factor. Moreover, more attention should be paid for these category of patients to decrease the incidence of falling down and the resulting fractures that might lead to mortality and morbidity.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0241201","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T21:10:37Z","timestamp":1605215437000},"page":"e0241201","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Bone mineral density in Palestinian patients with end-stage renal disease and the related clinical and biochemical factors: Cross-sectional study"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2655-6109","authenticated-orcid":true,"given":"Zaher","family":"Nazzal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahd","family":"Khader","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiba","family":"Zawyani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9837-1875","authenticated-orcid":true,"given":"Mazen","family":"Abdallah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5733-2589","authenticated-orcid":true,"given":"Osama","family":"Sawalmeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zakaria","family":"Hamdan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"issue":"2","key":"pone.0241201.ref001","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1159\/000319775","article-title":"Bone Mineral Density in Kuwaiti Patients with End-Stage Renal Disease","volume":"20","author":"R Gupta","year":"2011","journal-title":"Medical Principles and Practice"},{"issue":"6","key":"pone.0241201.ref002","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","article-title":"Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"67","author":"AS Levey","year":"2005","journal-title":"Kidney international"},{"issue":"2","key":"pone.0241201.ref003","doi-asserted-by":"crossref","first-page":"137","DOI":"10.7326\/0003-4819-139-2-200307150-00013","article-title":"National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification","volume":"139","author":"AS Levey","year":"2003","journal-title":"Annals of internal medicine"},{"issue":"2 SUPPL. 1","key":"pone.0241201.ref004","article-title":"K\/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification","volume":"39","author":"AS Levey","year":"2002","journal-title":"American Journal of Kidney Diseases"},{"issue":"2","key":"pone.0241201.ref005","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.pop.2008.01.008","article-title":"Chronic kidney disease and its complications","volume":"35","author":"R Thomas","year":"2008","journal-title":"Primary care: Clinics in office practice"},{"issue":"4","key":"pone.0241201.ref006","first-page":"195","article-title":"End-stage renal disease in the Middle East: A systematic review and meta-analysis","volume":"12","author":"L. Malekmakan","year":"2018","journal-title":"Iranian journal of kidney diseases"},{"year":"2018","author":"United States Renal Data System","key":"pone.0241201.ref007"},{"issue":"4","key":"pone.0241201.ref008","doi-asserted-by":"crossref","first-page":"832","DOI":"10.4103\/1319-2442.113913","article-title":"Prevalence of patients with end-stage renal disease on dialysis in the West Bank, Palestine","volume":"24","author":"MI Khader","year":"2013","journal-title":"Saudi Journal of Kidney Diseases and Transplantation"},{"issue":"1","key":"pone.0241201.ref009","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/1471-2474-10-60","article-title":"Factors associated with low bone mass in the hemodialysis patients\u2013a cross-sectional correlation study","volume":"10","author":"G-S Huang","year":"2009","journal-title":"BMC Musculoskeletal Disorders"},{"issue":"2","key":"pone.0241201.ref010","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1159\/000319775","article-title":"Bone Mineral Density in Kuwaiti Patients with End-Stage Renal Disease","volume":"20","author":"R Gupta","year":"2011","journal-title":"Medical Principles and Practice"},{"key":"pone.0241201.ref011","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2147\/IJNRD.S149877","article-title":"Pulse versus daily oral Alfacalcidol treatment of secondary hyperparathyroidism in hemodialysis patients: a randomized controlled trial","volume":"11","author":"O. Sawalmeh","year":"2018","journal-title":"International journal of nephrology and renovascular disease"},{"issue":"3","key":"pone.0241201.ref012","first-page":"78","article-title":"Hyperparathyroidism of renal disease","volume":"20","author":"NK Yuen","year":"2016","journal-title":"The Permanente journal"},{"article-title":"Linda McCann. Executive summary of the 2017 KDIGO Chronic Kidney Disease\u2013Mineral and Bone Disorder (CKD-MBD) Guideline Update: what\u2019s changed and why it matters","year":"2017","author":"Markus Ketteler","key":"pone.0241201.ref013"},{"issue":"2","key":"pone.0241201.ref014","first-page":"58","article-title":"Relationship of bone density with serum parathyroid hormone in hemodialysis patients; a single center study","volume":"6","author":"B Omidvar","year":"2018","journal-title":"Journal of Parathyroid Disease"},{"issue":"3","key":"pone.0241201.ref015","doi-asserted-by":"crossref","first-page":"300","DOI":"10.3109\/08860221003611661","article-title":"Bone mineral densitometry in patients on hemodialysis: difference between genders and what to measure","volume":"32","author":"L Orlic","year":"2010","journal-title":"Renal Failure"},{"key":"pone.0241201.ref016","unstructured":"015 ISCD Official Positions\u2013Adult [Internet]. 2015. Available from: http:\/\/www.iscd.org\/official-positions\/2015-iscd-official-positions-adult\/."},{"issue":"7041","key":"pone.0241201.ref017","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1136\/bmj.312.7041.1254","article-title":"Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures","volume":"312","author":"D Marshall","year":"1996","journal-title":"Bmj"},{"issue":"4","key":"pone.0241201.ref018","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s001980050224","article-title":"Interim report and recommendations of the World Health Organization task-force for osteoporosis.","volume":"10","author":"H.K. Genant","year":"1999","journal-title":"Osteoporosis international"},{"issue":"2","key":"pone.0241201.ref019","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1056\/NEJMcp042092","article-title":"Screening for osteoporosis","volume":"353","author":"L.G. Raisz","year":"2005","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"pone.0241201.ref020","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s11657-012-0110-3","article-title":"Risk factors for diminished bone mineral density among male hemodialysis patients\u2014a cross-sectional study","volume":"7","author":"S Mirfakhraee","year":"2012","journal-title":"Archives of Osteoporosis"},{"issue":"5","key":"pone.0241201.ref021","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/j.transproceed.2004.05.069","article-title":"Predictors of bone mineral density in patients on hemodialysis","volume":"36","author":"D Zayour","year":"2004","journal-title":"Transplantation proceedings"},{"issue":"4","key":"pone.0241201.ref022","doi-asserted-by":"crossref","first-page":"469","DOI":"10.3109\/08860221003675260","article-title":"Risk factors leading to reduced bone mineral density in hemodialysis patients with metabolic syndrome","volume":"32","author":"DN Binici","year":"2010","journal-title":"Renal Failure"},{"issue":"2","key":"pone.0241201.ref023","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1081\/JDI-120038501","article-title":"Bone mineral density in patients on maintenance hemodialysis and effect of chronic hepatitis C virus infection","volume":"26","author":"AE Yucel","year":"2004","journal-title":"Ren Fail"},{"issue":"1","key":"pone.0241201.ref024","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s11255-009-9702-2","article-title":"Bone mineral density and parathyroid function in patients on maintenance hemodialysis","volume":"43","author":"C. Ambrus","year":"2011","journal-title":"International urology and nephrology"},{"issue":"3","key":"pone.0241201.ref025","first-page":"342","article-title":"Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis\u2013a cross-sectional, longitudinal study","volume":"23","author":"M Nybo","year":"2013"},{"issue":"4","key":"pone.0241201.ref026","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/j.1440-1797.2009.01159.x","article-title":"Bone density in patients with chronic kidney disease stages 4\u20105","volume":"14","author":"SM Ott","year":"2009","journal-title":"Nephrology"},{"issue":"2","key":"pone.0241201.ref027","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/S0272-6386(99)70302-1","article-title":"Risk factors for vertebral fractures in renal osteodystrophy.","volume":"33","author":"K. Atsumi","year":"1999","journal-title":"American journal of kidney diseases,"},{"issue":"3","key":"pone.0241201.ref028","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/1744-9987.12678","article-title":"Parathyroid Hormone and Bone in Dialysis Patients.","volume":"22","author":"JJ Kazama","year":"2018","journal-title":"Therapeutic Apheresis and Dialysis"},{"issue":"7","key":"pone.0241201.ref029","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.2215\/CJN.09470913","article-title":"Bone mineral density and serum biochemical predictors of bone loss in patients with CKD on dialysis.","volume":"9","author":"H.H. Malluche","year":"2014","journal-title":"Clinical Journal of the American Society of Nephrology,"},{"key":"pone.0241201.ref030","article-title":"2020. Mineral bone disorder and osteoporosis in hemodialysis patients","volume":"60","author":"M. Slouma","journal-title":"Advances in Rheumatology"},{"issue":"12","key":"pone.0241201.ref031","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1359\/jbmr.2002.17.12.2094","article-title":"Pathophysiology and recent advances in the management of renal osteodystrophy","volume":"17","author":"G. Elder","year":"2002","journal-title":"Journal of Bone and Mineral Research"},{"issue":"1","key":"pone.0241201.ref032","first-page":"25","article-title":"Osteoporosis and Associated Risk Factors for Chronic Hemodialysis Patients","volume":"16","year":"2002","journal-title":"Acta Nephrologica"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T21:11:07Z","timestamp":1605215467000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241201"}},"subtitle":[],"editor":[{"given":"Sakamuri V.","family":"Reddy","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,12]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0241201","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2020,11,12]]}}}