Vnitr Lek 2012, 58(11):817-824

Bone mineral density in patients with chronic renal failure at the start of haemodialysis therapy

I. Valkovský^1,5,*, J. Tvrdík⁶, A. Martínek^1,5, R. Olšanská¹, J. Dědochová¹, N. Petejová^1,5, Z. Švagera^2,5, M. Pernicová³, Z. Čermáková^4,5

¹ Interní klinika FN Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc.

² Oddělení klinické biochemie Ústavu lékařské diagnostiky FN Ostrava, primář RNDr. Zdeněk Švagera, Ph.D.

³ Ústav radiodiagnostický FN Ostrava, přednosta doc. MUDr. Petr Krupa, CSc.

⁴ Krevní centrum FN Ostrava, primář MUDr. Zuzana Čermáková, Ph.D.

⁵ Lékařská fakulta Ostravské univerzity Ostrava, děkan doc. MUDr. Arnošt Martínek, CSc.

⁶ Přírodovědecká fakulta Ostravské univerzity Ostrava, děkan doc. PaedDr. Dana Kričfaluši, CSc.

Aim:
To determine bone mineral density (BMD) in nephrology patients at the start of haemodialysis therapy and its dependence on some laboratory and clinical characteristics of the study set.

Methods:
There were 73 newly haemodialyzed patients accepted in the 3 months period from the beginning of the chronic haemodialysis program. Each patient underwent measurements BMD with DXA method in the area of lumbar spine and the left hip. Ca, P and parathormone values were measured once per month during 3 months before BMD determination. 25-OH vitamin D, estradiol and blood pH were determined only once before the densitometry examination.

Results:
BMD in the osteoporosis zone was measured most often in the area of femoral neck in the whole group (prevalence 35 %) and also in the single groups of patients (men, women, non-diabetics, diabetics). In women, BMD findings corresponding to osteoporosis values in the total hip were significantly more often (p < 0.01). In the area of femoral neck and lumbar spine the percentage of women and men in single groups (osteoporosis, osteopenia and normal values) was without any statistical differentiation. Diabetics and non-diabetics did not distinguish in the number of findings osteoporosis and osteopenia in any followed areas of skeleton. As the significant factors predicating BMD there were found: calcium level and sex for the area of the total hip, calcium level, blood pH and height for the femoral neck, and sex for the lumbar spine only. The certain degree of vitamin D deficiency was measured in nearly all patients (mean 11.5 ± 7.4 μg/l), and hypocalcaemia was demonstrated in one fifth of patients.

Conclusion:
Bone mineral density values and some laboratory parameters affecting bone metabolism are often abnormal in the patients entering the chronic haemodialysis program and must be taken into consideration.

Keywords: bone mineral density; haemodialysis; osteoporosis; vitamin D; hypocalcaemia

Received: May 17, 2012; Accepted: August 24, 2012; Published: November 1, 2012  Show citation