Maintenance of Bone Mass in Patients Receiving Dialytic Therapy

Sharon M. Moe, Byunghee O.H. Yu, Stuart M. Sprague

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

To determine what factors contribute to and change bone mineral density (BMD) in dialysis patients, serial lumbar spine dual x-ray absorptiometry studies were analyzed by stepwise regression analysis in 67 black dialysis patients. The patients were 50.5 ± 2.0 years of age (mean ± SE) and 49% were men; the patients had received dialytic therapy for 3.7 ± 0.5 years. The mean initial BMD z-score was 0.147 ± 0.182. By cross-sectional analysis, the BMD increased in the male and premenopausal female patients but decreased in the postmenopausal female patients by 2.5% g/cm2/decade of life, less than that observed in black patients with normal renal function. Univariate analysis and stepwise regression analysis demonstrated radiographic evidence of osteopenia (β-coefficient = -0.180 ± 0.050; P = 0.001) and prior parathyroidectomy (β-coefficient = 0.133 ± 0.070; P = 0.054) as the only variables significantly correlated to the BMD. The effects of biochemical variables and different treatments on the ΔBMD, calculated as the difference between each patient's first and second BMDs divided by the interval in years, were evaluated by stepwise regression analysis in 41 patients. The mean interval between the two BMDs was 18.4 ± 1.02 months (range, 5 to 34 months) and the ΔBMD was 0.025 ± 0.018 g/cm2/yr, increasing in 65% of the patients. By univariate and stepwise regression analysis, the mean monthly serum total alkaline phosphatase concentration was the only variable that correlated with the ΔBMD (β-coefficient = 0.0001; P = 0.030). Eleven patients had three or more BMDs, demonstrating an increase in bone mass with time on dialysis (mean slope = 0.004 ± 0.004). In conclusion, black dialysis patients have a relative preservation of lumbar spine BMD over time. The etiology for the maintenance of bone density is unclear, and whether this represents structurally sound lamellar bone and is protective to fracture is unknown.

Original languageEnglish (US)
Pages (from-to)300-307
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume22
Issue number2
DOIs
StatePublished - Jan 1 1993

Keywords

  • Dialysis
  • bone density
  • parathyroidectomy
  • renal osteodystrophy

ASJC Scopus subject areas

  • Nephrology

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