Estimation of bone mineral density and architectural parameters of the distal radius in hemodialysis patients using peripheral quantitative computed tomography.

We analyzed bone changes in a series of hemodialysis patients followed up for a maximum of 299 months by assessing bone mineral density (BMD) and architectural parameters of the distal radius using peripheral quantitative computed tomography (pQCT), and determined the predictors of skeletal changes in these patients. No significant differences in trabecular BMD (BMD(T)) were found compared with BMD(T) of the normal control. In contrast, cortical BMD (BMD(C)) was significantly decreased compared with BMD(C) of the normal controls. Hemodialysis patients had significantly lower values for cortical bone area, cortical thickness, moment of inertia, and polar moment of inertia than the age-matched controls. From single and multiple regression analysis, the most significant predictor of metabolic bone disease in these cases was found to be duration of hemodialysis. In addition, increases in serum alkaline phosphatase and intact parathyroid hormone in secondary hyperparathyroidism were found to correlate with a decrease in pQCT values in cortical bone; as such, these increases were also found to be a predictive. The present study confirms that the reduction in both BMD(C) and architectural parameters in hemodialysis patients occurs partly because of prolonged hemodialysis and secondary hyperparathyroidism. In addition, immobilization, dietary factors, daily intake of calcium or vitamin D, and so on must be taken into account when clarifying the causes of skeletal complications resulting from hemodialysis.