Abstract: Objective To analyze the progression of vertebral fractures (VF) in maintenance hemodialysis (MHD) patients using quantitative computed tomography (QCT) and to explore the significant role of baseline lumbar spine trabecular volumetric bone mineral density (Tb.vBMD) in VF progression. Methods  A total of 44 MHD patients from October 2019 to April 2022 were enrolled. Baseline and follow-up lumbar QCT images with an interval of more than two years were collected. Tb.vBMD was measured, and VF was assessed using the Genant semi-quantitative method. VF progression was diagnosed if new VFs occurred, existing VFs worsened in grade, or the number of fractured vertebrae increased. Patients were divided into a VF progression group (n=17) and a non-progression group (n=27). Logistic regression was used to examine the impact of baseline lumbar Tb.vBMD and other factors on VF progression.  Results  Among the 44 patients, 34 had no VF at baseline, while 10 had existing VFs. In the VF progression group, 11 patients developed new VFs. The number of fractured vertebrae increased from 16 at baseline to 41 at follow-up. Baseline lumbar Tb.vBMD was negatively correlated with VF progression (OR=0.842, 95% CI: 0.715～0.992, P=0.039). A decrease of 10 mg/cm³ in baseline Tb.vBMD was associated with a 15.8% increase in the risk of VF progression. Both the progression and non-progression groups showed significant decreases in follow-up lumbar Tb.vBMD compared to baseline (P=0.002 and P=0.007, respectively), but the degree of decrease did not differ significantly between the two groups.  Conclusion  VF progression is significant in MHD patients. Baseline lumbar Tb.vBMD, rather than the degree of Tb.vBMD decline, is an independent risk factor for VF progression in MHD patients. Tb.vBMD measured by QCT has certain predictive value for VF occurrence in this population.

Key words: Maintenance hemodialysis, Vertebral fracture progression, Lumbar trabecular volumetric bone mineral density, Quantitative CT