Abstract: Objective  To investigate the influencing factors of fracture occurrence in maintenance hemodialysis (MHD) patients.  Methods  A prospective cohort of MHD patients admitted to Xi'an Hospital of Traditional Chinese Medicine from August 2020 to December 2022 was selected and randomly divided into a modeling group and a validation group in a 7:3 ratio. The modeling group was further categorized into fracture and non-fracture subgroups based on fracture occurrence. Multivariate logistic regression was used to analyze risk factors for fractures in MHD patients. A nomogram model for predicting fracture risk was constructed using R software. Receiver operating characteristic (ROC) curves were plotted to evaluate the discriminative ability of the nomogram, and calibration curves were generated to assess model consistency.  Results  A total of 358 patients were included, with 251 in the modeling group and 107 in the validation group. In the modeling group, 38 patients (15.14%) experienced fractures. The fracture group had higher proportions of patients aged ≥65 years, females, and those with intact parathyroid hormone (iPTH) ≥300 ng/L compared to the non-fracture group (χ²=13.014, 11.765, 10.158; P＜0.001, 0.001, 0.001, respectively). The fracture group also showed lower rates of active vitamin D supplementation and lower skeletal muscle mass index (χ²/t = 13.553, 6.138; both P＜0.001). The most common fracture type was vertebral compression fractures (31.58%), followed by hip fractures (23.68%). Multivariate logistic regression identified that the risk factors were age ≥65 years (OR=11.150, 95% CI: 3.790～32.086; P＜0.001), female sex (OR=5.443, 95% CI: 1.977～14.985; P=0.001), and iPTH ≥300 ng/L (OR=31.784, 95% CI: 9.457～106.826; P＜0.001); while higher skeletal muscle mass index (OR=0.421, 95% CI: 0.200～0.885; P=0.022) and active vitamin D supplementation (OR=0.055, 95% CI: 0.014～0.206; P＜0.001) were protective factors. The area under the ROC curve (AUC) was 0.872 for the modeling group (Hosmer-Lemeshow test: χ²=7.124, P=0.704) and 0.924 for the validation group (Hosmer-Lemeshow test: χ²=6.353, P=0.687), indicating good discrimination and calibration.  Conclusion  Age, female sex, and elevated iPTH are independent risk factors for fractures in MHD patients, while higher skeletal muscle mass index and active vitamin D supplementation serve as protective factors. The constructed nomogram model demonstrated good predictive performance for fracture risk in this population.

Key words: Human body composition, Maintenance hemodialysis, Fracture, Influence factor