Valkovsky Ivo, Olsanska Renata, Tvrdik Josef, Martinek Arnost, Svagera Zdenek, Pernicova Marketa, Dedochova Jarmila, Cermakova Zuzana
Clinic of Internal Medicine, University Hospital Ostrava, Ostrava, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015 Mar;159(1):93-9. doi: 10.5507/bp.2013.087. Epub 2013 Nov 29.
Patients with chronic kidney disease (CKD) have significant disorders of bone and mineral metabolism. In addition, they can also develop other bone disorders including osteoporosis. This study evaluated the bone mineral density (BMD) of patients at the start of hemodialysis treatment as well as the relationship between BMD and possible risk factors or biochemical markers.
The study was performed in 82 patients (28 females, 54 males). BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur.
We found a high prevalence of 25-hydroxyvitamin D deficiency (96%; mean levels 30.0 ± 17.7 nmol/L) and a reduction of BMD in comparison with gender- and age-matched normal population values at the total hip (Z-score = -0.31 ± 1.11) and the femoral neck (Z-score = -0.48 ± 1.16), but not at the lumbar spine (Z-score = 0.68 ± 1.81). The prevalence of T-scores ≤ -2.5 SD in the group of patients over 50 years was 52.0% in females and 33.3% in males. BMD positively correlated: with male gender and calcium levels at all measured sites, with age at the lumbar spine and with weight or BMI at the proximal femur.
CKD patients at the start of hemodialysis treatment had a high prevalence of low T-score values, corresponding to values for osteoporosis in the general population. BMD at the proximal femur was below the expected average for age and gender, but at the lumbar spine, BMD in hemodialysis patients was above average in persons without known CKD.
慢性肾脏病（CKD）患者存在明显的骨与矿物质代谢紊乱。此外，他们还可能发生包括骨质疏松症在内的其他骨骼疾病。本研究评估了血液透析治疗开始时患者的骨密度（BMD），以及BMD与可能的危险因素或生化标志物之间的关系。
该研究纳入了82例患者（28例女性，54例男性）。采用双能X线吸收法（DXA）测量腰椎和股骨近端的骨密度。
我们发现25-羟维生素D缺乏的患病率很高（96%；平均水平为30.0±17.7nmol/L），与年龄和性别匹配的正常人群相比，全髋部（Z值=-0.31±1.11）和股骨颈（Z值=-0.48±1.16）的骨密度降低，但腰椎的骨密度未降低（Z值=0.68±1.81）。50岁以上患者组中T值≤-2.5SD的患病率在女性中为52.0%，在男性中为33.3%。骨密度呈正相关：在所有测量部位与男性性别和钙水平相关，在腰椎与年龄相关，在股骨近端与体重或体重指数相关。
血液透析治疗开始时的CKD患者低T值患病率很高，与普通人群中骨质疏松症的值相当。股骨近端的骨密度低于年龄和性别的预期平均值，但在腰椎，血液透析患者的骨密度高于无CKD的人群。
