Frazão João M, Martins Patrícia
Nephrology Department, Hospital de S. João, Medical School and Nephrology Research and Development Unit, University of Porto, Porto, Portugal.
Curr Opin Nephrol Hypertens. 2009 Jul;18(4):303-7. doi: 10.1097/MNH.0b013e32832c4df0.
Adynamic bone disease has recently been associated with increased risk of vascular calcification. This review focuses on the emerging data in adynamic bone disease, its clinical consequences and therapeutic implications.
There is a lack of good biochemical markers of parathyroid status, bone formation and reabsorption to allow a secure diagnosis of bone disease. Recent data have suggested a possible link between bone activity and vascular calcification. Cardiovascular calcification is an independent predictor of mortality. Adynamic bone is associated with a very low capacity of bone to incorporate calcium in the bone compartment and inability to handle an extra calcium load. A positive association between vascular calcifications and low bone turnover has been suggested. Calcium-containing phosphate binders, active vitamin D therapy and high calcium dialysate may enhance vascular calcifications in the presence of adynamic bone disease.
There is recent evidence suggesting a negative impact of calcium load in the progression of vascular calcification in dialysis patients with chronic kidney disease stage 5 with adynamic bone disease. The current therapeutic approach to these patients should focus on reduction of calcium and vitamin D load to restore parathyroid activity.
动力缺乏型骨病最近被认为与血管钙化风险增加有关。本综述聚焦于动力缺乏型骨病的最新数据、其临床后果及治疗意义。
缺乏用于可靠诊断骨病的甲状旁腺状态、骨形成及骨吸收的良好生化标志物。近期数据提示骨活性与血管钙化之间可能存在联系。心血管钙化是死亡率的独立预测因素。动力缺乏型骨病与骨将钙纳入骨腔室的能力极低以及无法应对额外钙负荷有关。已有人提出血管钙化与低骨转换之间存在正相关。在动力缺乏型骨病存在的情况下，含钙磷结合剂、活性维生素D治疗及高钙透析液可能会加重血管钙化。
最近有证据表明，在患有动力缺乏型骨病的慢性肾脏病5期透析患者中，钙负荷对血管钙化进展有负面影响。当前针对这些患者的治疗方法应侧重于降低钙和维生素D负荷，以恢复甲状旁腺活性。
