Estimation of bone mineral density and architectural parameters of the distal radius in hemodialysis patients using peripheral quantitative computed tomography

Abstract

We analyzed bone changes in a series of hemodialysis patients followed up for a maximum of 299 months by assessing bone mineral density (BMD) and architectural parameters of the distal radius using peripheral quantitative computed tomography (pQCT), and determined the predictors of skeletal changes in these patients. No significant differences in trabecular BMD (BMD(T)) were found compared with BMD(T) of the normal control. In contrast, cortical BMD (BMD(C)) was significantly decreased compared with BMD(C) of the normal controls. Hemodialysis patients had significantly lower values for cortical bone area, cortical thickness, moment of inertia, and polar moment of inertia than the age-matched controls. From single and multiple regression analysis, the most significant predictor of metabolic bone disease in these cases was found to be duration of hemodialysis. In addition, increases in serum alkaline phosphatase and intact parathyroid hormone in secondary hyperparathyroidism were found to correlate with a decrease in pQCT values in cortical bone; as such, these increases were also found to be a predictive. The present study confirms that the reduction in both BMD(C) and architectural parameters in hemodialysis patients occurs partly because of prolonged hemodialysis and secondary hyperparathyroidism. In addition, immobilization, dietary factors, daily intake of calcium or vitamin D, and so on must be taken into account when clarifying the causes of skeletal complications resulting from hemodialysis.

Comparison of laboratory and imaging methods associated with bone metabolism in patients with or without renal failure under the age of 45 years with elevated parathyroid hormone levels

“…Some studies have shown that low BMD measurements were more prevalent in patients with CKD like our findings while several other studies have reported no relationship between CKD and low BMD measurements [22][23][24][25]. In our study, except Z score at Ward's triangle, all of the T and Z scores were found statistically significantly lower in CKD patients especially T and Z scores at lumbar 3 and 4 [7,[26][27][28]. In our study, we found that the BMD measurement at L2-L4 region was significantly higher than that at femur neck in both genders (p < 0.01).…”

Alterations of bone microstructure and strength in end-stage renal failure

“…The first studies used instruments with a 350-μm resolution and showed a lower cortical vBMD, but no significant differences in trabecular BMD in ESRD patients [34][35][36] compared with healthy controls. A recent crosssectional study in 52 adults on maintenance hemodialysis demonstrated that reductions in pQCT values of the radius cortical bone were strongly predictive of vertebral and fragility peripheral fractures, but not pQCT trabecular vBMD and DXA aBMD [37].…”

Fracture risk assessment in patients with chronic kidney disease

“…Three studies have reported on the use of pQCT in patients with stage 5 CKD on hemodialysis [3,54,55], while one study reported on using it in patients with stage 5 CKD on continuous ambulatory peritoneal dialysis [56]. All were cross-sectional and report a preferential decrease in cortical but not trabecular density in line with the hypothesis that bone loss in CKD patients is primarily due to elevated PTH.…”