Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients.
Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients.
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DOI：
10.1093/ndt/gfg403
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发表时间：
2003-11
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影响因子：
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通讯作者：
P. Ureña;O. Bernard-Poenaru;A. Ostertag;C. Baudoin;M. Cohen-Solal;T. Cantor;M. de Vernejoul
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文献类型：
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作者：
P. Ureña;O. Bernard-Poenaru;A. Ostertag;C. Baudoin;M. Cohen-Solal;T. Cantor;M. de Vernejoul
终末期肾病通常与骨代谢改变有关。方法：为了研究骨密度（BMD）的决定因素和骨折的危险因素，我们研究了70例患者，其中女性26例（绝经后23例），男性44例，年龄60.5 ± 14.3岁，接受标准血液透析（HD）治疗6.4 ± 6.8年。主要循环骨生化指标进行了评估，并在五个地点用Lunar DPX密度计测量BMD。BMD结果表示为年龄和性别的函数（Z评分）。结果：平均Z评分在桡骨中段（-2.75+/-1.23）显著降低，而在股骨颈（-0.42+/-1.13）和腰椎（0.02+/-2.13）以及全身（-0.62+/-1.53）正常。HD时间与桡骨中段和全身的Z评分呈负相关，但与其他部位无关。血清全段甲状旁腺激素（iPTH），全甲状旁腺激素或环化酶激活甲状旁腺激素（CAP）和骨特异性碱性磷酸酶浓度与Z评分在所有网站呈负相关。自透析治疗开始以来，70名患者中有21名患者共发生27处骨折（7根肋骨、7个踝关节、6个椎骨、3个肱骨、2个手腕和2个髋关节）。他们的全身Z评分显著低于无骨折患者，分别为-1.34+/-1.54 vs -0.37+/-1.46（P<0.031）;然而，他们在其他部位的Z评分没有差异。他们接受HD的时间更长，分别为10.4+/-9.5vs5.0 +/-5.1（P<0.003），HD 10年后骨折的相对风险增加了6.4倍。7例肋骨骨折患者在大多数部位的Z评分降低，但在桡骨中段没有降低。肋骨骨折与体重、脂肪量和血清瘦素水平显著降低相关，而其他骨折与此无关。结论：总之，血液透析患者桡骨中段的Z评分降低，与高血清PTH相关，但与骨折无关。骨折与HD的时间和全身Z评分较低相关。肋骨骨折是常见的，并与营养状况差。
BACKGROUND End-stage renal disease is often associated with altered bone metabolism. METHODS In order to investigate the determinant factors of bone mineral density (BMD) and the risk factors of fractures, we studied 70 patients; 26 women (23 post-menopausal) and 44 men, (mean+/-SD) aged 60.5+/-14.3 years, treated by standard haemodialysis (HD) for 6.4+/-6.8 years. Main circulating bone biochemical markers were assessed and BMD was measured with a Lunar DPX densitometer at five sites. BMD results are expressed as a function of age and gender (Z-score). RESULTS Mean Z-score was markedly decreased at the mid-radius (-2.75+/-1.23) whereas it was normal at the femoral neck (-0.42+/-1.13) and lumbar spine (0.02+/-2.13), and total body (-0.62+/-1.53). Time on HD was negatively correlated to the Z-score at the mid-radius and total body but not at the other sites. Serum intact parathyroid hormone (iPTH), whole PTH or cyclase activating PTH (CAP) and bone-specific alkaline phosphatase concentrations were negatively correlated with Z-scores at all sites. Twenty-one out of 70 patients had sustained a total of 27 fractures since the beginning of dialysis therapy (seven ribs, seven ankles, six vertebrae, three humerus, two wrists and two hips). They had a total body Z-score significantly lower than that of patients without fractures, -1.34+/-1.54 vs -0.37+/-1.46, respectively (P<0.031); however, their Z-scores at the other sites were not different. They were on HD for longer time, 10.4+/-9.5 vs 5.0+/-5.1, respectively (P<0.003), and the relative risk of skeletal fractures was 6.4 times greater after 10 years of HD. The seven patients with rib fractures had a decreased Z-score at most of the sites but not at the mid-radius. Rib fractures but no other fractures were associated with markedly decreased body weight, fat mass and serum leptin levels. CONCLUSIONS In conclusion, the Z-score at the mid-radius was decreased in HD patients and correlated with high serum PTH but not with fractures. Bone fractures were associated with the time passed on HD and with a low total body Z-score. Rib fractures were frequent and associated with a poor nutritional state.