[CT evaluation of trabecular and cortical bone mineral density of the lumbar spine in patients on hemodialysis].
It is difficult to evaluate the severity of bone involvement in patients on maintenance hemodialysis (HD) by the measurement of vertebral bone mineral density (BMD), since many endocrine factors influence bone metabolism, making the value of BMD variable from high to low. It is also difficult to interpret the BMD measured in one ROI (region of interest) since bone density distribution is sometimes very heterogenous. On the other hand QCT method is useful to evaluate the value of trabecular and cortical bone mineral density separately. Vertebral BMD was measured in 138 patients on maintenance HD, by using DEQCT (dual energy QCT). 161 patients without bone metabolic disorders were studied for control group. In patients on HD, various BMD values ranging from high to low were observed, and there was no correlation between BMD value and duration of HD. The number of patients with low mineral content was greater than that with high mineral content in both cortical and trabecular bone. The trabecular BMD decreased with age, and the speed of BMD decline was the same in both sexes. The rapid decrease of trabecular BMD after menopause seen in control female group was not observed in female patients on hemodialysis. The deviation of BMD from the age-matched average BMD value was smaller in older male patients than that in young male and female patients. In order to evaluate the difference of change between the trabecular and cortical bone at the same vertebra, cases in which discrepancy of Z-score was more than 0.2 were divided into three groups; group A: increased trabecular BMD (Z-score greater than 1), group B: decreased trabecular BMD (-1 greater than Z-score), group C: normal trabecular BMD (-1 less than Z-score less than 1), and in each group T/C ratio (Z-score of trabecular BMD/Z-score of cortical BMD ratio) was evaluated. In group A, almost all cases showed trabecular BMD to be higher than cortical, and in group B, 60% cases showed trabecular BMD to be lower than cortical, suggesting that the change of BMD in trabecular bone is greater than that in cortical bone.
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D000328:Adult; D000368:Aged; D015519:Bone Density; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed