Eriguchi R, Umakoshi J, Miura S, Sato Y
Sato Junkanki Hospital, 4-10-25 Asouda-cho, Matsuyama City, Ehime Prefecture, 790-0952, Japan.
Clin Nephrol. 2009 Dec;72(6):423-9. doi: 10.5414/cnp72423.
Postmenopausal women undergoing chronic hemodialysis are at risk of uremic bone disease and postmenopausal osteoporosis. There are few reports discussing the effects of raloxifene hydrochloride on chronic hemodialysis patients. We investigated whether differences in the effects of raloxifene on bone mineral density (BMD) are dependent on the level of intact parathyroid hormone (iPTH).
47 postmenopausal hemodialysis patients with osteoporosis were divided into two groups, i.e. Group A, with treatment, and Group B, without treatment by raloxifene hydrochloride (60 mg/day, three times per week) for 1 year. We evaluated the changes in BMD at the distal one-third of the radial bone and aortic calcification index (ACI) by plain abdominal computerized tomography. Furthermore, we compared the BMD and ACI results for patients with similar iPTH levels within each group.
After 1 year of raloxifene treatment, patients with iPTH levels of < 250 pg/ml in Group A showed significantly less BMD deterioration than similar patients in Group B (A: -0.31 +/- 1.7% vs. B: -3.71 +/- 0.7%, p = 0.04). However, raloxifene showed no difference in patients with iPTH levels of > or = 250 pg/ml in the two groups (A: -3.49 +/- 0.7% vs. B: -6.10 +/- 1.9%, p = 0.09). Among the patients with iPTH levels of < 250 pg/ml, changes in the ACI values were 1.30 +/- 0.3% for Group A and 1.67 +/- 1.0% for Group B. Among the patients with iPTH levels of (3) 250 pg/ml, the ACI values were 2.58 +/- 0.7% for Group A and 3.01 +/- 1.2% for Group B.
Raloxifene treatment was useful for the prevention of BMD deterioration in postmenopausal dialysis patients with controlled iPTH levels.
接受慢性血液透析的绝经后女性有患尿毒症骨病和绝经后骨质疏松症的风险。很少有报告讨论盐酸雷洛昔芬对慢性血液透析患者的影响。我们研究了雷洛昔芬对骨密度（BMD）影响的差异是否取决于完整甲状旁腺激素（iPTH）水平。
47例绝经后骨质疏松血液透析患者分为两组，即A组接受治疗，B组未接受盐酸雷洛昔芬治疗（60mg/天，每周三次），为期1年。我们通过腹部平扫计算机断层扫描评估桡骨远端三分之一处的骨密度变化和主动脉钙化指数（ACI）。此外，我们比较了每组中iPTH水平相似的患者的骨密度和ACI结果。
雷洛昔芬治疗1年后，A组中iPTH水平<250pg/ml的患者骨密度恶化程度明显低于B组中类似患者（A组：-0.31±1.7% vs. B组：-3.71±0.7%，p = 0.04）。然而，两组中iPTH水平≥250pg/ml的患者中雷洛昔芬没有差异（A组：-3.49±0.7% vs. B组：-6.10±1.9%，p = 0.09）。在iPTH水平<250pg/ml的患者中，A组的ACI值变化为1.30±0.3%，B组为1.67±1.0%。在iPTH水平≥250pg/ml的患者中，A组的ACI值为2.58±0.7%，B组为3.01±1.2%。
雷洛昔芬治疗对于预防iPTH水平得到控制的绝经后透析患者的骨密度恶化是有用的。
