Low molecular weight heparins and antiplatelet drugs, and bone mineral density in dialysis patients.
Variations in results concerning the influence of low molecular weight heparins (LMWHs) and antiplatelet drugs (APtDs) on bone mineral density (BMD) have led us to investigate whether dialysis patients receiving these drugs (group I) are characterized by a BMD different from that of patients not receiving such medications (group II). Group I consisted of 14 patients [mean age: 64.7 +/- 16.0 years; 4 on hemodialysis (HD), 10 on peritoneal dialysis (PD); dialysis duration: 22.7 months (range: 7.9 - 59.6 months)] who were regularly receiving LMWHs (4 HD patients) or APtDs (10 PD patients, 1 HD patient), or both, for at least 2 years. Group II consisted of 16 PD patients [mean age: 48.7 +/- 16.2 years; dialysis duration: 16.3 months (6.3 - 45.5 months)]. We evaluated BMD as assessed in the femoral neck and lumbar spine, serum parathyroid hormone, blood pH, and parameters of calcium-phosphate balance and nutritional state, and compared values between the two groups. As compared with group II, group I had significantly lower measurements in the femoral neck: BMD (0.711 +/- 0.100 g/cm2 vs. 0.904 +/- 0.124 g/cm2, p = 0.000), T score [-2.38 (range: -4.06 to -1.27) vs. -0.71 (range: -3.05 to 2.37), p = 0.000], Z score [-1.34 (range: -2.36 to -0.15) vs. 0.12 (range: -1.0 to 2.97), p = 0.001], BMD as a percentage of peak bone mass (69.1% +/- 9.0% vs. 94.4% +/- 16.6%, p = 0.000), BMD as a percentage age norm (81.6% +/- 9.7% vs. 103.4% +/- 18.5%, p = 0.000). We observed no other significant differences in examined parameters between the groups. Dialysis patients regularly receiving LMWHs or APtDs, or both, show lower BMD measures in the femoral neck; they therefore require more frequent monitoring of BMD and timely prophylaxis against osteoporosis.
Grzegorzewska
Alicja E
AE
Chair and Department of Nephrology, Transplantology and Internal Diseases, Karol Marcinkowski University of Medical Sciences, Poznań, Poland. alicja_grzegorzewska@yahoo.com
Młot-Michalska
Monika
M
D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced; D005272:Femur Neck; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008159:Lumbar Vertebrae; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006435:Renal Dialysis
D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors