Stein M S, Packham D K, Wark J D, Becker G J
University of Melbourne, Department of Medicine, Australia.
Clin Nephrol. 1999 Sep;52(3):172-8.
We report increases in axial and appendicular bone density after parathyroidectomy in renal patients. Bone density was recorded pre-operatively and at 6 weeks, 6 months and 1 year post-operatively. We have previously reported that axial bone density increased dramatically at 6 weeks but that there were no early cohort increases at the appendicular skeleton [Stein et al. 1997].
We now report that at six months, bone density had continued to increase at the lumbar spine and femoral neck, with median respective 6 months increases over baseline of 1.3 (p < 0.01) and 0.7 (p < 0.01 ) Z-scores. Bone density then appeared to stabilize at the axial skeleton. At the appendicular skeleton increases were significant at the one year time point with median respective increases at the ultradistal radius and one third radius of 0.46 (p < 0.05) and 0.49 (p < 0.05) Z-scores. The different pattern of responses to parathyroidectomy between the axial and appendicular sites supports the concept that appendicular bone turnover is slower than axial bone turnover. Furthermore, at the appendicular skeleton, bone turnover appears similar between cortical and trabecular bone.
In renal patients, bone density increases after parathyroidectomy at both the axial and appendicular skeleton. Axial increases are large and occur early. Appendicular increases occur at both cortical and trabecular sites but are slower than the axial changes.
我们报告了肾病患者甲状旁腺切除术后轴向和附属骨骼骨密度的增加情况。术前以及术后6周、6个月和1年记录骨密度。我们之前曾报告，轴向骨密度在6周时显著增加，但附属骨骼在早期队列中没有增加[斯坦因等人，1997年]。
我们现在报告，在6个月时，腰椎和股骨颈的骨密度持续增加，相对于基线，6个月时的Z值中位数分别增加了1.3（p < 0.01）和0.7（p < 0.01）。然后轴向骨骼的骨密度似乎趋于稳定。在附属骨骼，1年时间点时增加显著，超远端桡骨和三分之一桡骨处的Z值中位数分别增加了0.46（p < 0.05）和0.49（p < 0.05）。轴向和附属部位对甲状旁腺切除术的不同反应模式支持了附属骨骼骨转换比轴向骨骼骨转换慢的概念。此外，在附属骨骼，皮质骨和小梁骨之间的骨转换似乎相似。
在肾病患者中，甲状旁腺切除术后轴向和附属骨骼的骨密度均增加。轴向增加幅度大且发生早。附属骨骼的增加发生在皮质骨和小梁骨部位，但比轴向变化慢。
