title: Volumetric bone density and geometry assessed by peripheral quantitative computed tomography in uremic patients on maintenance hemodialysis.
abstract: The aim of this study was to establish, by means of peripheral quantitative computed tomography (pQCT) at the distal radius, the existence of cortical and/or trabecular osteopenia, and to assess the integrity of bone geometry in uremic patients undergoing maintenance hemodialysis. Our results show a clearcut selective reduction in volumetric cortical density, more evident in women (p = -0.0001) than men (p = 0.030), which appears to be independent of age and menopausal status. Trabecular density was not significantly changed in either sex. Cortical density of the patients correlated inversely with age (p = 0.003), duration of dialysis (p = 0.002) and parathyroid hormone (PTH) levels (p = 0.03). Trabecular density correlated only with age. Normally, cortical density is age-dependent and its reduction is accompanied by compensatory geometry changes. Compared with control subjects, in our female patients both cortical area and cortical thickness were reduced (p = 0.02 and 0.008), while cross-sectional area did not change (p = 0.67). Conversely, in the males only cross-sectional area was reduced (p = 0.02). In conclusion, in uremic patients we observed a selective cortical osteopenia, more evident in the female sex, and a sex-specific pattern of geometry impairment, with resultant apparent increased bone fragility in the uremic women. We suggest that the prolonged PTH excess could be responsible, directly and/or interacting with estrogen deficiency.
authors.affiliation: Second Internal Medicine Department, Nuovo Ospedale S. Giovanni di Dio, Florence, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Russo
authors.forename: G
authors.initials: G
authors.lastname: Taccetti
authors.forename: P
authors.initials: P
authors.lastname: Caneva
authors.forename: A
authors.initials: A
authors.lastname: Mannarino
authors.forename: P
authors.initials: P
authors.lastname: Maranghi
authors.forename: M
authors.initials: M
authors.lastname: Ricca
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011884:Radius / Q000000981:diagnostic imaging / Q000503:physiopathology; D006435:Renal Dialysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014511:Uremia / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
chemical_list: D010281:Parathyroid Hormone