1st Department of Internal Medicine, Semmelweis University, 2/a Koranyi S. u., 1083, Budapest, Hungary.
Int Urol Nephrol. 2011 Mar;43(1):191-201. doi: 10.1007/s11255-009-9702-2. Epub 2010 Jan 21.
The relationship between parathyroid function, an important determinant of bone turnover, and bone mineral density (BMD) in patients with chronic kidney disease is not fully understood. We wanted to analyze the association between BMD and parathyroid function in hemodialysis patients in details.
In a cross-sectional design, data from 270 patients (age 55 ± 15 years, 60% men, all Caucasian) on maintenance hemodialysis were analyzed. All patients underwent dual energy X-ray absorptiometry of the lumbar spine (LS), femoral neck (FN) and distal radius (DR). In addition to routine laboratory tests, blood samples were collected for iPTH, serum markers of bone metabolism (alkaline phosphatase, type I collagen crosslinked-C-telopeptide) and 25OH vitamin D.
Based on Z-scores, bone mineral density was moderately reduced only at the femoral neck in the total cohort. The average Z-score of the "low PTH" group (iPTH < 100 pg/ml) was not different from the Z-score of patients with iPTH in the "target range" (100-300 pg/ml) at any measurement site. While iPTH was negatively correlated with BMD at all measurement sites in patients with iPTH > 100 pg/ml (rho = -0.255, -0.278 and -0.251 for LS, FN and DR, respectively, P < 0.001 for all), BMD was independent of iPTH in patients with iPTH < 100 pg/ml. Furthermore, iPTH was not associated with serum markers of bone metabolism, but these markers were negatively correlated with BMD in the "low PTH" group.
Low PTH levels are not associated with low BMD in patients with end-stage kidney disease. Furthermore, bone metabolism seems to be independent of iPTH in patients with relative hypoparathyroidism likely reflecting skeletal resistance to PTH.
甲状旁腺功能是骨转换的一个重要决定因素，与慢性肾脏病患者的骨密度（BMD）之间的关系尚未完全阐明。我们旨在详细分析血液透析患者的 BMD 与甲状旁腺功能之间的关系。
采用横断面设计，对 270 名（年龄 55 ± 15 岁，60%为男性，均为白种人）维持性血液透析患者的数据进行分析。所有患者均接受腰椎（LS）、股骨颈（FN）和桡骨远端（DR）的双能 X 线吸收法测定。除常规实验室检查外，还采集血样以检测 iPTH、骨代谢血清标志物（碱性磷酸酶、I 型胶原交联 C 端肽）和 25OH 维生素 D。
基于 Z 评分，仅在总队列中股骨颈的骨矿物质密度中度降低。“低 PTH”组（iPTH < 100 pg/ml）的平均 Z 评分与 iPTH 处于“靶范围”（100-300 pg/ml）的患者在任何测量部位的 Z 评分均无差异。而在 iPTH > 100 pg/ml 的患者中，iPTH 与所有测量部位的 BMD 均呈负相关（LS、FN 和 DR 的 rho 值分别为-0.255、-0.278 和-0.251，均 P < 0.001），而在 iPTH < 100 pg/ml 的患者中，BMD 与 iPTH 无关。此外，iPTH 与骨代谢的血清标志物无关，但这些标志物在“低 PTH”组与 BMD 呈负相关。
在终末期肾病患者中，低 PTH 水平与低 BMD 无关。此外，在相对甲状旁腺功能减退的患者中，骨代谢似乎与 iPTH 无关，这可能反映了骨骼对 PTH 的抵抗。
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