Bone loss in diabetic patients with chronic kidney disease.
OBJECTIVE
We investigated whether loss of bone is detectable during follow-up of diabetic patients with chronic kidney disease (CKD).


METHODS
In 40 initially non-dialysed diabetic patients with CKD (isotopic glomerular filtration rate < 60 ml/min/1.73 m(2) or albumin excretion rate > 30 mg/24 h), body composition (DEXA scan) and glomerular filtration rate (GFR determined from (51)Cr-EDTA clearance) were measured at a 2-year interval, and compared by paired t-tests.


RESULTS
The 40 patients, mainly with Type 2 diabetes (n = 28), were men (n = 28), aged 65 +/- 11 years, with diabetes duration 18 +/- 11 years. GFR was initially 38.0 (range 8-89) ml/min/1.73 m(2). CKD progressed during follow-up: eight started haemodialysis and GFR declined in the 32 others (P < 0.05 vs. initial). T-scores for total body (initial -0.61 +/- 1.11, final -1.11 +/- 1.40; P < 0.001) and femoral neck (initial -1.88 +/- 0.15, final -2.07 +/- 0.15; P < 0.05) declined. Ten patients were osteopaenic at baseline (no osteoporosis), whereas most were osteopaenic (n = 21, P < 0.05) and five were osteoporotic at final assessment. The 16 patients who became osteopaenic or osteoporotic during follow-up did not differ from the others for the type of diabetes, age, GFR, albumin excretion rate, HbA(1c), GFR reduction and the requirement for dialysis during follow-up. They were all men (P < 0.01 by chi-squared test), with reduced initial total body T-score (-1.20 +/- 0.82, others -0.32 +/- 1.13; P < 0.05) and a lower body mass index (24.6 +/- 4.3; others 27.7 +/- 4.3; P < 0.05).


CONCLUSIONS
Bone loss, especially in the femoral neck, is progressive in diabetic patients with CKD.
Rigalleau
V
V
Université de Bordeaux 2-Victor Segalen, Bordeaux, France. vincent.rigalleau@wanadoo.fr
Lasseur
C
C
Raffaitin
C
C
Perlemoine
C
C
Barthe
N
N
Chauveau
P
P
Aparicio
M
M
Combe
C
C
Gin
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology*; D001851:Bone Diseases, Metabolic / Q000209:etiology* / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005265:Femoral Neck Fractures / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors