Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.
Clin Exp Nephrol. 2013 Feb;17(1):120-6. doi: 10.1007/s10157-012-0665-8. Epub 2012 Jul 26.
Cinacalcet markedly reduces the serum intact parathyroid hormone (PTH) level of hemodialysis (HD) patients with secondary hyperparathyroidism. Parathyroidectomy also reduces the serum intact PTH level of HD patients and it increases their bone mineral density (BMD). However, there is little information about the effect of cinacalcet on BMD or on the associations between bone markers and BMD in HD patients.
We performed a 1-year cohort study of 25 HD patients who had a serum intact PTH level above 300 pg/ml during treatment by conventional therapies, such as with active vitamin D, and cinacalcet was prescribed for 14 of them. BMD of the femoral neck and the serum levels of two circulating bone markers, alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (BSAP), were measured before and after treatment. The other 11 HD patients without cinacalcet treatment were defined as control group.
BMD significantly increased by 7.3 % during the 1 year of treatment in the cinacalcet group and decreased by 6.2 % during the same period in the control group, and cinacalcet therapy was independently associated with the changes in BMD after multiple regression analysis that included intact PTH (β = 7.57, P < 0.01). In the cinacalcet group, the serum ALP levels (R(2) = 0.315, P < 0.05) and BSAP levels (R(2) = 0.682, P < 0.01) levels were significantly negatively correlated with the changes in BMD, but the serum intact PTH levels were not significantly associated with the changes in BMD (R(2) = 0.011, P = 0.72).
One year of treatment with cinacalcet increased the BMD of the femoral neck in the HD cohort, especially in the patients who had higher serum ALP and BSAP levels at baseline.
西那卡塞显著降低继发性甲状旁腺功能亢进的血液透析（HD）患者的血清全段甲状旁腺激素（PTH）水平。甲状旁腺切除术也降低了 HD 患者的血清全段 PTH 水平，并增加了他们的骨密度（BMD）。然而，关于西那卡塞对 BMD 的影响，或关于 HD 患者的骨标志物与 BMD 之间的关联的信息很少。
我们对 25 名 HD 患者进行了为期 1 年的队列研究，这些患者在接受常规治疗（如活性维生素 D）期间的血清全段 PTH 水平超过 300pg/ml，其中 14 名患者被开了西那卡塞。在治疗前后测量了股骨颈的 BMD 和两种循环骨标志物的血清水平，碱性磷酸酶（ALP）和骨特异性碱性磷酸酶（BSAP）。未接受西那卡塞治疗的 11 名 HD 患者被定义为对照组。
在西那卡塞组，BMD 在 1 年内显著增加了 7.3%，而在对照组，BMD 在同一时期减少了 6.2%，并且在包括全段 PTH 的多元回归分析中，西那卡塞治疗与 BMD 的变化独立相关（β=7.57，P<0.01）。在西那卡塞组，血清 ALP 水平（R²=0.315，P<0.05）和 BSAP 水平（R²=0.682，P<0.01）与 BMD 的变化呈显著负相关，但血清全段 PTH 水平与 BMD 的变化无显著相关性（R²=0.011，P=0.72）。
西那卡塞治疗 1 年可增加 HD 队列的股骨颈 BMD，特别是在基线时血清 ALP 和 BSAP 水平较高的患者中。
