Bone mineral density in patients with chronic renal failure at the start of haemodialysis therapy
Authors:
I. Valkovský 1,5; J. Tvrdík 6; A. Martínek 1,5; R. Olšanská 1; J. Dědochová 1; N. Petejová 1,5; Z. Švagera 2,5; M. Pernicová 3; Z. Čermáková 4,5
Authors‘ workplace:
Interní klinika FN Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc.
1; Oddělení klinické biochemie Ústavu lékařské diagnostiky FN Ostrava, primář RNDr. Zdeněk Švagera, Ph. D.
2; Ústav radiodiagnostický FN Ostrava, přednosta doc. MUDr. Petr Krupa, CSc.
3; Krevní centrum FN Ostrava, primář MUDr. Zuzana Čermáková, Ph. D.
4; Lékařská fakulta Ostravské univerzity Ostrava, děkan doc. MUDr. Arnošt Martínek, CSc.
5; Přírodovědecká fakulta Ostravské univerzity Ostrava, děkan doc. PaedDr. Dana Kričfaluši, CSc.
6
Published in:
Vnitř Lék 2012; 58(11): 817-824
Category:
Original Contributions
Overview
Aim:
To determine bone mineral density (BMD) in nephrology patients at the start of haemodialysis therapy and its dependence on some laboratory and clinical characteristics of the study set.
Methods:
There were 73 newly haemodialyzed patients accepted in the 3 months period from the beginning of the chronic haemodialysis program. Each patient underwent measurements BMD with DXA method in the area of lumbar spine and the left hip. Ca, P and parathormone values were measured once per month during 3 months before BMD determination. 25-OH vitamin D, estradiol and blood pH were determined only once before the densitometry examination.
Results:
BMD in the osteoporosis zone was measured most often in the area of femoral neck in the whole group (prevalence 35 %) and also in the single groups of patients (men, women, non-diabetics, diabetics). In women, BMD findings corresponding to osteoporosis values in the total hip were significantly more often (p < 0.01). In the area of femoral neck and lumbar spine the percentage of women and men in single groups (osteoporosis, osteopenia and normal values) was without any statistical differentiation. Diabetics and non-diabetics did not distinguish in the number of findings osteoporosis and osteopenia in any followed areas of skeleton. As the significant factors predicating BMD there were found: calcium level and sex for the area of the total hip, calcium level, blood pH and height for the femoral neck, and sex for the lumbar spine only. The certain degree of vitamin D deficiency was measured in nearly all patients (mean 11.5 ± 7.4 µg/l), and hypocalcaemia was demonstrated in one fifth of patients.
Conclusion:
Bone mineral density values and some laboratory parameters affecting bone metabolism are often abnormal in the patients entering the chronic haemodialysis program and must be taken into consideration.
Key words:
bone mineral density – haemodialysis – osteoporosis – vitamin D – hypocalcaemia
Sources
1. Bellorin-Font E, Adams J, Cunningham J. Osteopenia in uremia. In: Olgaard K, Salutsky IB, Silver J. The Spectrum of Mineral and Bone Disorders in Chronic Kidney Disease. Oxford University Press 2010: 235–251.
2. Rix M, Andreassen H, Eskildsen P et al. Bone mineral density and biochemical markers of bone turnover in patients with predialysis chronic renal failure. Kidney Int 1999; 56: 1084–1093.
3. Dusilová Sulková S et al. Renální osteopatie. Praha: Maxdorf 2007: 160–161.
4. ISCD Official Positions [online]. © 2007 [cit. 2012-03-26]. Dostupné z: http://www.iscd.org/Visitors/pdfs/ISCD2007OfficialPositions-Adult.pdf
5. Miller PD. Diagnosis and treatment of osteoporosis in chronic renal disease. Semin Nephrol 2009; 29: 144–155.
6. Moe S, Drüeke T, Cunningham J et al. Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006; 69: 1945–1953.
7. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am J Kidney 2003; 42: (Suppl. 3): 12–16.
Pei Y, Hercz G, Greenwood C et al. Renal osteodystrophy in diabetic patients. Kidney Int 1993; 44: 159–164.
9. Sotorník I, Kutílek Š et al. Kostní minerály a skelet při chronickém onemocnění ledvin. Praha: Galén 2011: 344–347.
10. Dusilová Sulková S et al. Renální osteopatie. Praha: Maxdorf 2007: 156–157.
11. Hutchinson MS, Figenschau Y, Almås B et al. Serum 25-hydroxyvitamin D levels in subjects with reduced glucose tolerance and type 2 diabetes – The Tromsø OGTT-Study. Int J Vitam Nutr Res 2011; 81: 317–327.
12. Sotorník I, Kutílek Š et al. Kostní minerály a skelet při chronickém onemocnění ledvin. Praha: Galén 2011: 342.
13. Miller JE, Kovesdy CP, Norris KC et al. Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients. Am J Nephrol 2010; 32: 403–413.
14. Pilz S, Iodice S, Zittermann A et al. Vitamin D status and mortality risk in CKD: a meta-analysis of prospective studies. Am J Kidney 2011; 58: 374–382.
15. Kandula P, Dobre M, Schold JD et al. Vitamin D supplementation in chronic kidney disease: a systematic review and meta-analysis of observational studies and randomized controlled trials. Clin J Am Soc Nephrol 2011; 6: 50–62.
16. Garriguet D. Bone health: osteoporosis, calcium and vitamin D. Health Rep 2011; 22: 7–
17. Vyskočil V. Osteoporóza a ostatní nejčastější metabolická onemocnění skeletu. Praha: Galén 2009: 27–28.
18. Vestergaard P, Rejnmark L, Mosekilde L. Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 2005; 16: 134–141.
19. Společnost pro metabolická onemocnění skeletu. Doporučené postupy pro diagnostiku a terapii postmenopauzální osteoporózy II – část první [online]. © 2007 [cit. 2012-03-26]. Dostupné z: http://www.smos.cz/docs/dp_smos1.pdf.
20. KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int 2009; 76: (Suppl. 13): 32–49.
21. Cunningham J, Sprague SM et al. Osteoporosis in chronic kidney disease. Am J Kidney 2004; 43: 566–571.
22. Mal L, Oei L, Jiang L et al. Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. Eur J Epidemiol 2012; 27: 319–332.
23. Ohlídalová K, Mareš J, Ferda J et al. Hodnocení kostní denzity u hemodialyzovaných pacientů. Ces Radiol 2007; 1: 68–73.
24. Tomida K, Hamano T, Mikami S et al. Serum 25-hydroxyvitamin D as an independent determinant of 1-84 PTH and bone mineral density in non-diabetic predialysis CKD patients. Bone 2009; 44: 678–683.
25. Binici DN, Gunes N. Risk factors leading to reduce bone mineral density in hemodialysis patients with metabolic syndrome. Ren Fail 2010; 32: 469–474.
26. Waugh EJ, Lam MA, Hawker GA et al. Risk factors for low bone mass in healthy 40–60 year old women: a systematic review of the literature. Osteoporos Int 2009; 20: 1–21.
27. Papaioannou A, Kennedy CC, Cranney A et al. Risk factors for low BMD in healthy men age 50 years or older: a systematic review. Osteoporos Int 2009; 20: 507–518.
28. Dusilová Sulková S et al. Renální osteopatie. Praha: Maxdorf 2007: 50.
29. Vyskočil V. Současné možnosti léčby osteoporózy.Vnitř Lék 2011; 58: 749–758.
30. FRAX ® WHO Fracture Risk Assessment Tool [online]. © World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK 2011 [cit. 2012-03-26]. Dostupné z: http://www.shef.ac.uk/FRAX/ dne 29.5.2011.
31. Alem AM, Sherrard DJ, Gillen DL et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 2000; 58: 396–399.
Ott SM. Rewiev article: Bone density in patients with chronic kidney disease stages 4–5. Nephrology 2009; 14: 395–403.
33. Moe SM. Vascular calcification and renal osteodystrophy relationship in chronic kidney disease. Eur J Clin Invest 2006; 36: (Suppl. 2): 51–62.
34. Miller PD. Diagnosis and treatment of osteoporosis in chronic renal disease. Semin Nephrol 2009; 29: 144–155.
36. Gal-Moscovici A, Sprague SM. Osteoporosis and chronic kidney disease. Semin Dial 2007; 20: 423–430.
37. Dusilová Sulková S. Kostní choroba u chronického selhání ledvin a její moderní terapie. Vnitř Lék 2011; 57: 620–625.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2012 Issue 11
Most read in this issue
- Coronary-subclavian steal syndrome, a complication following surgical revascularization of myocardium
- Vitamin D metabolism and current options for therapeutic activation of vitamin D receptor in patients with chronic kidney disease or renal failure
- Left ventricular myxoma – an unexpected cause of dyspnoea and fever in a young patient
- Carcinoid and its cardiac manifestation