Horber F F, Casez J P, Steiger U, Czerniak A, Montandon A, Jaeger P
Klinik Schloss Mammern, Switzerland.
J Bone Miner Res. 1994 Jan;9(1):1-9. doi: 10.1002/jbmr.5650090102.
Renal transplant patients exhibit increased rates of trabecular bone fractures, probably due to glucocorticoid-induced osteopenia, which is known to occur within 6 months after kidney grafting. This mineral loss at a mostly trabecular site (lumbar spine) contrasts with a gain at the radius, which consists mainly of cortical bone. However, the early effects of kidney transplantation on the other parts of the human skeleton and the time course of these changes during the first 5 months after transplantation remain unknown. Therefore, 34 kidney transplant recipients were prospectively followed immediately after kidney grafting (12 +/- 1 days, mean +/- SEM, and then on a monthly basis up to 152 +/- 3 days) and compared with 34 normal healthy volunteers matched for age, sex, and body mass index. Bone mineral measurements of whole body (n = 34), lumbar spine (n = 32), and upper femur (n = 23) were performed using dual-energy x-ray absorptiometry (Hologic QDR 1000W). At time of transplantation, lumbar bone mineral density (BMD) and BMD of the upper femur were lower (p < 0.01) in female but not male patients compared with controls. Lumbar BMD decreased by 1.6 +/- 0.2% per month in both sexes (p < 0.01), whereas BMD of upper femur further decreased in males (p < 0.01) but only tended to decrease in females. At time of transplantation, whole-body bone area (BA), bone mineral content (BMC), and BMD were decreased by about 8, 15, and 9%, respectively, in patients compared with controls (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
肾移植患者小梁骨骨折发生率增加，可能是由于糖皮质激素诱导的骨质减少，已知这种情况在肾移植后6个月内就会出现。这种主要发生在小梁部位（腰椎）的矿物质流失与桡骨的矿物质增加形成对比，桡骨主要由皮质骨组成。然而，肾移植对人体骨骼其他部位的早期影响以及移植后前5个月这些变化的时间进程仍不清楚。因此，对34名肾移植受者在肾移植后立即进行前瞻性随访（12±1天，平均±标准误，然后每月随访一次，直至152±3天），并与34名年龄、性别和体重指数相匹配的正常健康志愿者进行比较。使用双能X线吸收法（Hologic QDR 1000W）对全身（n = 34）、腰椎（n = 32）和股骨上段（n = 23）进行骨矿物质测量。移植时，与对照组相比，女性患者的腰椎骨矿物质密度（BMD）和股骨上段BMD较低（p < 0.01），男性患者则不然。两性的腰椎BMD每月均下降1.6±0.2%（p < 0.01），而男性股骨上段BMD进一步下降（p < 0.01），女性仅呈下降趋势。移植时，与对照组相比，患者的全身骨面积（BA）、骨矿物质含量（BMC）和BMD分别下降了约8%、15%和9%（p < 0.01）。（摘要截选至250字）
