2nd Department of Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Bone Metabolism Unit, Affidea, Prague, Czech Republic.
Int Urol Nephrol. 2020 Feb;52(2):379-385. doi: 10.1007/s11255-020-02378-1. Epub 2020 Feb 3.
Low bone mineral density (BMD) and trabecular bone score (TBS) are established risk factors for fractures even in hemodialysis population and they seem to be significantly lower in comparison with general population. The aim of our study was to describe 2-year loss of BMD and TBS and their predictors in hemodialysis patients.
From 59 non-selected patients (mean age 67.6 ± 13.1 years) from one dialysis centre, treated with hemodiafiltration (HDF), clinical and laboratory characteristics were obtained and densitometry examinations (with BMD and TBS results) were performed initially and at the end of 2-year follow-up.
Two-year decrease in BMD of lumbar spine reached 4.1% (ns), of proximal femur 9.1% (p = 0.004), and of femoral neck 1.3% (ns). In the co-educated cohort, BMD decrease in all the sites correlated significantly with age and only the change of BMD of lumbar spine was negatively associated with serum calcium (r = - 0.39; p = 0.04) and dialysis vintage (r = - 0.387; p = 0.062), no other predictors of BMD loss were identified. Some predictors of BMD loss were identified with regard to gender. TBS decrease was 0.05 (3.9%; p = 0.03), and similarly, it was not predicted by any of selected parameters. No differences in BMD changes or TBS were observed between the patients with and without fractures.
In patients with HDF, significant BMD and TBS annual losses were observed, and they were associated only with age and (in BMD of lumbar spine) with serum calcium and dialysis vintage.
即使在血液透析人群中，低骨密度（BMD）和骨小梁评分（TBS）也是骨折的既定危险因素，与普通人群相比，它们似乎明显更低。我们的研究目的是描述血液透析患者 2 年内 BMD 和 TBS 的丧失及其预测因素。
从一家透析中心的 59 名未经选择的患者（平均年龄 67.6±13.1 岁）中，获得了临床和实验室特征，并进行了骨密度测定检查（包括 BMD 和 TBS 结果），最初进行检查，然后在 2 年随访结束时进行检查。
腰椎 BMD 2 年下降 4.1%（无统计学意义），股骨近端 9.1%（p=0.004），股骨颈 1.3%（无统计学意义）。在接受共同教育的队列中，所有部位的 BMD 下降均与年龄显著相关，只有腰椎 BMD 的变化与血清钙呈负相关（r=-0.39；p=0.04）和透析时间呈负相关（r=-0.387；p=0.062），未发现其他 BMD 丢失的预测因素。根据性别确定了一些 BMD 丢失的预测因素。TBS 下降 0.05（3.9%；p=0.03），同样，也没有选择的参数可以预测 TBS 的丢失。在有和没有骨折的患者之间，BMD 变化或 TBS 没有差异。
在接受 HDF 的患者中，观察到 BMD 和 TBS 明显的年度丢失，并且仅与年龄以及（腰椎 BMD）与血清钙和透析时间有关。
