{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T09:13:17Z","timestamp":1778749997334,"version":"3.51.4"},"reference-count":25,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The spectrum of chronic kidney disease\u2014mineral and bone disorder (CKD-MBD) is changing and adynamic bone disease (ABD) is now believed to constitute the majority of CKD-MBD in the developed world. However, its prevalence and risk factors are poorly described in the literature. Its diagnosis requires bone biopsy, but biochemical criteria including parathyroid hormone (PTH) levels show good correlation. The aim of this study is to understand the prevalence of ABD in our patients with kidney failure (KF) on hemodialysis (HD), identify the risk factors for its development, and in doing so enable early intervention to modify the risk factors specific to our population. Methods: This is a retrospective cross-sectional study. A total of 201 prevalent adult patients on maintenance HD for at least 3 months were recruited. Patients with previous parathyroidectomy were excluded. Relevant data including clinical and biochemical parameters, prescribed dialysate and medications, and clinical outcomes were collected. ABD was diagnosed if any intact PTH (iPTH) level during the study period was &lt;15 pmol\/L. Results: Of the 201 patients in the study (median age 64.5 years), 35 (17.4%) patients had ABD. In the multivariable logistic regression model, the adjusted odds ratio (OR) of ABD was higher with a higher mean adjusted serum calcium level, while the concurrent use of non-calcium-based binders was associated with lower odds of ABD. Activated vitamin D use was also associated with lower odds of ABD, likely reflecting past occurrence of ABD, prompting a pre-emptive discontinuation of activated vitamin D. Overall, 17% of patients had had fractures without significant association with ABD. The mean PTH level was in the target range (15\u201360 pmol\/L) in 41% of the cohort. Cardiovascular complications were not significantly associated with ABD. Conclusions: Approximately one in every six HD patients in our care have ABD as diagnosed by the iPTH level. Targeting a lower serum calcium level and using non-calcium-based binders may reduce the occurrence of ABD and will need to be tested in prospective studies.<\/jats:p>","DOI":"10.3390\/jcm15103758","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:50:15Z","timestamp":1778745015000},"page":"3758","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Correlates of Adynamic Bone Disease in Patients with Kidney Failure in Singapore"],"prefix":"10.3390","volume":"15","author":[{"given":"Siew Kit","family":"Shuit","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin Yan Qing","family":"Wee","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan Kai","family":"Teh","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangxia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regina Shaoying","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manohar","family":"Bairy","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Deng, L., Guo, S., Liu, Y., Zhou, Y., Liu, Y., Zheng, X., Yu, X., and Shuai, P. (2025). Global, regional, and national burden of chronic kidney disease and its underlying etiologies from 1990 to 2021: A systematic analysis for the Global Burden of Disease Study 2021. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-21851-z"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1093\/ckj\/sfac218","article-title":"Temporal trends in prevalence and mortality for chronic kidney disease in China from 1990 to 2019: An analysis of the Global Burden of Disease Study 2019","volume":"16","author":"Li","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_3","unstructured":"GBD Chronic Kidney Disease Collaboration (2020). Global, regional, and national burden of chronic kidney disease, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395, 709\u2013733."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1093\/ndt\/gfac165","article-title":"Increasing numbers and improved overall survival of patients on kidney replacement therapy over the last decade in Europe: An ERA Registry study","volume":"38","author":"Huijben","year":"2023","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.3399\/bjgp20X714125","article-title":"Comorbidity in chronic kidney disease: A large cross-sectional study of prevalence in Scottish primary care","volume":"71","author":"MacRae","year":"2021","journal-title":"Br. J. Gen. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Nagy, E., Sobh, M.M., Abdalbary, M., Elnagar, S., Elrefaey, R., Shabaka, S., Elshabrawy, N., Shemies, R., Tawfik, M., and Santos, C.G.S. (2022). Is Adynamic Bone Always a Disease? Lessons from Patients with Chronic Kidney Disease. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237130"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1097\/01.ASN.0000129337.50739.48","article-title":"Arterial calcifications and bone histomorphometry in end-stage renal disease","volume":"15","author":"London","year":"2004","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"89","DOI":"10.2337\/dc20-1913","article-title":"Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000\u20132015","volume":"44","author":"Cheng","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13098-017-0278-1","article-title":"The impact of type 2 diabetes on bone metabolism","volume":"9","author":"Sanches","year":"2017","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1038\/ki.1994.380","article-title":"Development of adynamic bone in patients with secondary hyperparathyroidism after intermittent calcitriol therapy","volume":"46","author":"Goodman","year":"1994","journal-title":"Kidney Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1038\/ki.2008.60","article-title":"Adynamic bone in patients with chronic kidney disease","volume":"73","author":"Andress","year":"2008","journal-title":"Kidney Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2530162","DOI":"10.1080\/0886022X.2025.2530162","article-title":"Adynamic bone disorder in chronic kidney disease: Meta-analysis and narrative review of potential biomarkers as diagnosis and therapeutic targets","volume":"47","author":"Chao","year":"2025","journal-title":"Ren. Fail."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1053\/j.ajkd.2015.06.023","article-title":"Diagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients With CKD Treated by Dialysis","volume":"67","author":"Sprague","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.kint.2021.04.043","article-title":"Differentiating the causes of adynamic bone in advanced chronic kidney disease informs osteoporosis treatment","volume":"100","author":"Haarhaus","year":"2021","journal-title":"Kidney Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1046\/j.1523-1755.2002.00450.x","article-title":"Update on vitamin D and its newer analogues: Actions and rationale for treatment in chronic renal failure","volume":"62","author":"Malluche","year":"2002","journal-title":"Kidney Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.semnephrol.2014.09.008","article-title":"Adynamic bone disease: From bone to vessels in chronic kidney disease","volume":"34","author":"Bover","year":"2014","journal-title":"Semin. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1002\/jbmr.309","article-title":"Renal osteodystrophy in the first decade of the new millennium: Analysis of 630 bone biopsies in black and white patients","volume":"26","author":"Malluche","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_18","first-page":"198","article-title":"Serum albumin levels, an additional factor implicated in hyperparathyroidism outcome in peritoneal dialysis: A prospective study with paired bone biopsies","volume":"22","author":"Bajo","year":"2006","journal-title":"Adv. Perit. Dial."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1053\/ajkd.2000.19812","article-title":"Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone","volume":"36","author":"Coco","year":"2000","journal-title":"Am. J. Kidney Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1093\/ndt\/gfq304","article-title":"Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study","volume":"26","author":"Guinsburg","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"c211","DOI":"10.1159\/000321642","article-title":"Association between very low PTH levels and poor survival rates in haemodialysis patients: Results from the French ARNOS cohort","volume":"118","author":"Jean","year":"2011","journal-title":"Nephron Clin. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"582","DOI":"10.51248\/.v43i02.1536","article-title":"Prevalence and biochemical profile of adynamic bone disease in a hemodialysis population","volume":"43","author":"Geethanjali","year":"2023","journal-title":"Biomedicine"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Carbonare, L.D., Valenti, M.T., Giannini, S., Gallieni, M., Stefani, F., Ciresa, R., Politi, C., and Fusaro, M. (2021). Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194617"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1093\/ndt\/gfw468","article-title":"Bone biopsy practice patterns across Europe: The European renal osteodystrophy initiative\u2014A position paper","volume":"32","author":"Evenepoel","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"(2017). Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 7, 1\u201359.","DOI":"10.1016\/j.kisu.2017.04.001"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3758\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T08:33:28Z","timestamp":1778747608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3758"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":25,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103758"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103758","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}