Slouma Maroua, Sahli Hela, Bahlous Afef, Laadhar Lilia, Smaoui Wided, Rekik Sonia, Gharsallah Imen, Sallami Meriem, Moussa Fatma Ben, Elleuch Mohamed, Cheour Elhem
Department of Internal Medicine, Military Hospital, Tunis El Manar University, 1007, Tunis, Tunisia.
Department of Rheumatology, Rabta Hospital, Tunis El Manar University, Tunis, Tunisia.
Adv Rheumatol. 2020 Feb 26;60(1):15. doi: 10.1186/s42358-020-0118-0.
Bone disease is common in patients undergoing hemodialysis. It is the result of bone turnover abnormalities and the decrease of bone mineral density (BMD). We aimed to determine the usefulness of serum bone turnover markers and BMD measurement by dual-energy x-ray absorptiometry (DXA) in hemodialysis patients.
We conducted a cross-sectional study including 90 hemodialysis for more than 12 months. Bone mineral density was assessed by DXA. Peripheral blood samples were obtained from each patient before dialysis in a fasting state within a week of the DXA. Biochemical variables of calcium and phosphate were measured. One bone formation marker (bone-specific alkaline phosphatase (bAP), one bone resorption marker (carboxy-terminal telopeptides of type 1 collagen (CTX)) were measured. Total alkaline phosphatase (TAP), intact parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) which is a bone-derived hormone were also measured.
CTX values were 6.25 times higher than the normal limit of the assay. Bone alkaline phosphatase levels were less than 10 ng/mL in 28.8% of cases. 23% of patients have osteoporosis and 45% have osteopenia. Femoral BMD had negative correlations with age and PTH levels. FGF23 levels were significantly increased in patients with osteoporosis affecting the lumbar. The levels of bAP and CTX showed a positive correlation. Both circulating bAP and CTX levels showed also positive correlations with PTH levels. Fractures, observed in 12.2% of cases, were associated with low PTH values and the existence of osteoporosis.
Our study showed that osteoporosis and fracture are common in dialysis patients. The reduced BMD was associated with advanced age and elevated levels of PTH. Markers of bone turnover and FGF23 may play a role in the diagnosis of bone disease in hemodialysis patients. DXA measurement is necessary for the monitoring for bone loss.
骨病在接受血液透析的患者中很常见。它是骨转换异常和骨矿物质密度（BMD）降低的结果。我们旨在确定血清骨转换标志物和双能X线吸收法（DXA）测量BMD在血液透析患者中的有用性。
我们进行了一项横断面研究，纳入了90例血液透析超过12个月的患者。通过DXA评估骨矿物质密度。在DXA检查前一周内，于空腹状态下在每次透析前采集每位患者的外周血样本。测量钙和磷的生化变量。测量一种骨形成标志物（骨特异性碱性磷酸酶（bAP））、一种骨吸收标志物（1型胶原羧基末端肽（CTX））。还测量了总碱性磷酸酶（TAP）、完整甲状旁腺激素（PTH）和成纤维细胞生长因子23（FGF23，一种骨源性激素）。
CTX值比检测正常上限高6.25倍。28.8%的病例骨碱性磷酸酶水平低于10 ng/mL。23%的患者患有骨质疏松症，45%患有骨质减少症。股骨BMD与年龄和PTH水平呈负相关。在影响腰椎的骨质疏松症患者中，FGF23水平显著升高。bAP和CTX水平呈正相关。循环中的bAP和CTX水平也与PTH水平呈正相关。12.2%的病例观察到骨折，与低PTH值和骨质疏松症的存在有关。
我们的研究表明，骨质疏松症和骨折在透析患者中很常见。BMD降低与高龄和PTH水平升高有关。骨转换标志物和FGF23可能在血液透析患者骨病的诊断中起作用。DXA测量对于监测骨质流失是必要的。
