Department of Nephrology, Papageorgiou General Hospital, Thessaloniki, Greece.
Am J Nephrol. 2012;36(3):238-44. doi: 10.1159/000341864. Epub 2012 Aug 31.
Insufficient evidenced-based information is available for the treatment of osteoporosis in hemodialysis (HD) patients.
In 102 HD patients, bone mineral density (BMD) was measured twice 16 ± 3 months apart. In the second BMD measurement 66 of them had a femoral neck (FN) T-score <-2.5. Of these 66 patients, 38 consented to a bone biopsy. Depending on both the bone biopsy findings and parathyroid hormone levels, patients were assigned to treatment groups. Eleven patients with osteitis fibrosa and iPTH >300 pg/ml received cinacalcet, 11 with osteitis fibrosa and iPTH <300 pg/ml received ibandronate, 9 with adynamic bone disease received teriparatide, and 7 with mild abnormalities received no treatment. A third BMD measurement was done after an average treatment period of 13-16 months. We compared the annual percent change of FN and lumbar spine (LS) BMD before and during treatment.
FN and LS BMD decreased significantly in the cinacalcet group, with an annual change of 3.6 and 3.4% before treatment to -4.2% (p = 0.04) and -7.7% (p = 0.02) during treatment, respectively. In the teriparatide group, FN and LS BMD increased, although not significantly, with an annual change of -5.4 and -2.6% before treatment to 2.7 and 4.9% during treatment, respectively. In both the ibandronate and the no treatment groups, BMD change rate remained negative during the whole study.
Teriparatide administration improved BMD in HD patients with adynamic bone disease, although these results did not reach statistical significance. In HD patients with osteitis fibrosa, ibandronate did not improve BMD while cinacalcet reduced BMD.
对于血液透析（HD）患者的骨质疏松症治疗，目前缺乏基于证据的充分信息。
在 102 例 HD 患者中，两次测量骨密度（BMD），间隔 16 ± 3 个月。在第二次 BMD 测量中，66 例股骨颈（FN）T 评分<-2.5。在这 66 例患者中，有 38 例同意进行骨活检。根据骨活检结果和甲状旁腺激素（PTH）水平，将患者分配到治疗组。11 例纤维性骨炎和 iPTH >300 pg/ml 的患者接受西那卡塞治疗，11 例纤维性骨炎和 iPTH <300 pg/ml 的患者接受伊班膦酸盐治疗，9 例动力性骨病患者接受特立帕肽治疗，7 例轻度异常患者未接受治疗。平均治疗 13-16 个月后进行第三次 BMD 测量。我们比较了治疗前后 FN 和腰椎（LS）BMD 的年变化率。
西那卡塞组 FN 和 LS BMD 显著下降，治疗前的年变化率分别为 3.6%和 3.4%，治疗期间分别为-4.2%（p = 0.04）和-7.7%（p = 0.02）。特立帕肽组 FN 和 LS BMD 虽无显著增加，但呈负向变化，治疗前的年变化率分别为-5.4%和-2.6%，治疗期间分别为 2.7%和 4.9%。伊班膦酸盐组和未治疗组整个研究期间 BMD 变化率均为负值。
特立帕肽治疗可改善 HD 患者动力性骨病的 BMD，尽管这些结果未达到统计学意义。在 HD 纤维性骨炎患者中，伊班膦酸盐不能改善 BMD，而西那卡塞降低了 BMD。
