Bone mineral densitometry in patients on hemodialysis: difference between genders and what to measure.
BACKGROUND
Chronic kidney disease (CKD) and osteoporosis are important health problems. There is an interrelationship between osteoporosis and CKD. Bone densitometry is the "gold" standard in the diagnosis of osteoporosis. Unfortunately, there are some problems with the interpretation of bone densitometry in CKD patients. The goal of this study was to determine bone mineral density (BMD) in CKD patients, to assess the difference between genders and different sites of bone densitometry correlation between BMD and laboratory parameters, and to assess the most optimal measuring site.


METHODS
We studied 134 hemodialysis (HD) patients (62 females, 72 males). The mean age was 56.4+/-12.4 years and the mean duration of HD was 54.4+/-60 months. BMD of the lumbar spine (posterior-anterior projection and lateral projection), hip (femoral neck, trochanter, intertrochanter, total femur, the Ward's Triangle), and forearm (ultradistal (UD), middistal (MID), distal third portion, and total forearm) was measured using dual X-ray absorptiometry (DXA) (Hologic Delphi apparatus). Values were expressed as BMD, T-score, and Z-score.


RESULTS
Females had lower values of BMD in all measurement points. There were no significant differences in T- and Z-scores of forearm between males and females. Age was in a positive correlation with lumbar spine BMD in males and females. There was a negative correlation with neck and forearm BMD in both groups. Serum parathyroid hormone (PTH) was also in negative correlation with hip and forearm BMD in both groups. The best correlation of BMD in different sites was between forearm and neck.


CONCLUSIONS
BMD data in CKD patients should be interpreted with caution and appendicular skeletal sites should be included in the evaluation.
Orlic
Lidija
L
Department of Nephrology, University Hospital Rijeka, Rijeka, Croatia. lidija.orlic@ri.t-com.hr
Crncevic
Zeljka
Z
Pavlovic
Drasko
D
Zaputovic
Luka
L
D015502:Absorptiometry, Photon; D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis* / Q000209:etiology; D002118:Calcium / Q000097:blood; D002908:Chronic Disease; D005260:Female; D005542:Forearm / Q000000981:diagnostic imaging; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000628:therapy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis; D012727:Sex Characteristics
D010281:Parathyroid Hormone; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002118:Calcium