Iseri Ken, Mizobuchi Masahide, Shishido Kanji, Hida Noriko
Department of Clinical Pharmacy, Division of Clinical Research and Development, School of Pharmacy, Showa University, Tokyo, Japan.
Jinsei-kai Kasai dialysis Clinic, Tokyo, Japan.
Clin Kidney J. 2024 Aug 12;17(8):sfae240. doi: 10.1093/ckj/sfae240. eCollection 2024 Aug.
The longitudinal changes in hip-bone microstructures and estimated bone strength in dialysis patients, and the impact of chronic kidney disease-mineral and bone disorder (CKD-MBD) biomarkers on these changes, remain insufficiently explored.
This retrospective study examined changes in cortical and trabecular bone compartments and estimated bone-strength indices, obtained by using 3D-SHAPER software, in the hip regions of 276 dialysis patients over up to 2.5 years. We used multivariate mixed models to investigate the associations between time-dependent CKD-MBD biomarkers and bone health metrics.
There was a significant decrease in areal bone mineral density (aBMD), integral volumetric BMD (vBMD), trabecular vBMD, cortical thickness and cortical surface BMD (sBMD). Similar deteriorations were found in estimated bone-strength indices [cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (SM) and buckling ratio]. Neither serum calcium nor phosphate levels were significantly associated with changes in three-dimensional parameters or estimated bone-strength indices. In contrast, serum alkaline phosphatase levels showed a significant inverse correlation with aBMD and CSA. The intact-parathyroid hormone (i-PTH) was significantly inversely correlated with aBMD, integral vBMD, trabecular vBMD, cortical thickness, cortical vBMD, CSA, CSMI and SM. When applying the KDIGO criteria as a sensitivity analysis, the higher PTH group had significant negative associations with aBMD, integral vBMD, cortical vBMD, cortical thickness and cortical sBMD. Notably, the lower PTH group showed a positive significant correlation with integral vBMD and trabecular vBMD.
Elevated PTH, not low PTH, was associated with deterioration of hip-bone microstructures. Better management of PTH levels may play a crucial role in the hip-bone microstructure in dialysis patients.
透析患者髋部骨微结构和估计骨强度的纵向变化，以及慢性肾脏病 - 矿物质和骨异常（CKD - MBD）生物标志物对这些变化的影响，仍未得到充分研究。
这项回顾性研究通过使用3D - SHAPER软件，检测了276例透析患者在长达2.5年时间里髋部区域皮质骨和小梁骨腔室的变化以及估计的骨强度指数。我们使用多变量混合模型来研究随时间变化的CKD - MBD生物标志物与骨骼健康指标之间的关联。
骨面积密度（aBMD）、整体体积骨密度（vBMD）、小梁vBMD、皮质厚度和皮质表面骨密度（sBMD）均显著下降。在估计的骨强度指数[横截面积（CSA）、截面惯性矩（CSMI）、截面模量（SM）和屈曲比]方面也发现了类似的恶化情况。血清钙和磷水平与三维参数或估计的骨强度指数变化均无显著关联。相比之下，血清碱性磷酸酶水平与aBMD和CSA呈显著负相关。完整甲状旁腺激素（i - PTH）与aBMD、整体vBMD、小梁vBMD、皮质厚度、皮质vBMD、CSA、CSMI和SM均呈显著负相关。在将KDIGO标准作为敏感性分析应用时，较高PTH组与aBMD、整体vBMD、皮质vBMD、皮质厚度和皮质sBMD存在显著负相关。值得注意的是，较低PTH组与整体vBMD和小梁vBMD呈显著正相关。
甲状旁腺激素升高而非降低与髋部骨微结构恶化有关。更好地控制甲状旁腺激素水平可能对透析患者髋部骨微结构起着关键作用。
