Coco M, Rush H
Montefiore Medical Center, Bronx, NY 10467, USA.
Am J Kidney Dis. 2000 Dec;36(6):1115-21. doi: 10.1053/ajkd.2000.19812.
To study the complications of renal osteodystrophy in patients with end-stage renal disease, we reviewed the incidence of hip fractures in our outpatient dialysis population from 1988 to 1998. One thousand two hundred seventy-two patients were treated for a total of 4,039 patient-years; 56 hip fractures were documented during this period. The incidence of hip fractures was many times greater in the dialysis patients than in the general population in each of the age-, race-, and sex-matched subgroups. The 1-year mortality rate from the hip fracture event was nearly two and a half times greater in the dialysis patients compared with the general population. The incidence of hip fractures in the first half of the decade was similar to that observed in the second half. When parathyroid hormone (PTH) levels were evaluated, we determined that patients with lower serum PTH levels were more likely to sustain a hip fracture than patients with higher PTH levels (P: < 0.006). In addition, we determined that patients with lower PTH levels had an earlier mortality than patients with higher PTH levels (P: < 0.03). We conclude that despite more aggressive therapy directed toward bone health in our dialysis patients in recent years, the incidence of hip fractures and their devastating morbidity and mortality remained unchanged over the past decade. Lower PTH levels may predispose to earlier mortality.
为研究终末期肾病患者肾性骨营养不良的并发症，我们回顾了1988年至1998年门诊透析患者中髋部骨折的发生率。1272例患者接受治疗，总计4039患者年；在此期间记录了56例髋部骨折。在每个年龄、种族和性别匹配的亚组中，透析患者髋部骨折的发生率比普通人群高很多倍。与普通人群相比，透析患者因髋部骨折事件导致的1年死亡率高出近两倍半。十年前半期髋部骨折的发生率与后半期相似。在评估甲状旁腺激素（PTH）水平时，我们确定血清PTH水平较低的患者比PTH水平较高的患者更易发生髋部骨折（P：<0.006）。此外，我们还确定PTH水平较低的患者比PTH水平较高的患者死亡更早（P：<0.03）。我们得出结论，尽管近年来我们对透析患者的骨骼健康采取了更积极的治疗措施，但在过去十年中，髋部骨折的发生率及其严重的发病率和死亡率并未改变。较低的PTH水平可能易导致更早死亡。
