engleski

Mineral bone density in haemodialysis patients: difference between patients according to age

In patients with chronic kidney disease there is an increased risk of reduced bone mass. The goal of this work was to compare and investigate the difference in bone mineral density (BMD), and correlation between clinical and laboratory parameters in patients younger than 50 years and patients older than 65 years who are regularly treated by haemodialysis (HD). The test subjects were comprised of 35 patients younger than 50 and 35 patients older than 65. BMD of the hip, forearm and the lumbar spine was measured using dual X-ray absorptiometry. Values were expressed as BMD, T-score and Z-score. The average duration of HD of patients younger than 50 years was 52.1±63.4 months, the average BMI was 24.0±3.3 kg/m2, and the average value of PTH was 72.4±63.2 pmol/L. The average duration of HD of patients older than 65 years was 49.5±49.5 months, the average BMI was 25.1±4.3 kg/m2, and the average value of PTH was 49.3±53.4 pmol/L. Among the established parameters there was no statistically significant difference between the groups of patients. BMD in the area of the lumbar spine in patients younger than 50 was 0.942±0.143 g/cm2, and in patients older than 65 it was 0.980±0.237 g/cm2 (P=NS). BMD in the area of the femoral neck in patients younger than 50 was 0.811±0.147 g/cm2, and in patients older than 65 it was 0.710±0.131 g/cm2 (P=0, 006). BMD of the total hip in patients younger than 50 was 0.915±0.153 g/cm2, and in patients older than 65 it was 0.830±0g/cm2 (P=NS). BMD in the area of the forearm: ultradistal(UD) portion in patients younger than 50 was 0.405±0.072g/cm2, and in patients older than 65 it was 0.351±0.112 g/cm2, mid(MID) portion in patients younger than 50 was 0.589±0.095g/cm2, and in patients older than 65 it was 0.514±0.120 g/cm2 (P=0.02), one-third (1/3) in patients younger than 50 was 0.711±0.106 g/cm2, and in patients older than 65 it was 0.640±0.139 g/cm2 (P=0.02). T- score in all measuring points was lower in older patients, except in the area of the lumbar spine, AP projection. Older patients had a great Z- score in all measuring sites. In patients younger than 50 BMD, as well as PTH and AP, significantly correlated with the duration of HD in the area of the forearm, while in the area of the lumbar spine and the hip there was no correlation with the established parameters. In patients older than 65 BMD in the area of the hip there was a significant correlation with age. There was also a significant correlation with PTH and AP at all measuring points. Based on these results, we can conclude that, as expected, older patients had lower BMD at all measuring points, except in the area of the lumbar spine in A-P projection, which, of course, is not due to an actually better BMD but most probably the effect of degenerative changes or vascular calcification. Older patients had a higher Z- score at all measuring points, which means that they varied less from the healthy population of the same age, gender and race. Among younger patients the effect of PTH was more strongly express in the forearm, dominated by cortical bone. In older patients there is a significant correlation between the level of PTH and BMD at all measuring points.

bone mineral density; hemodialysis;

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