Volumetric bone density and geometry assessed by peripheral quantitative computed tomography in uremic patients on maintenance hemodialysis

Osteoporos Int. 1998;8(5):443-8. doi: 10.1007/s001980050089.

Abstract

The aim of this study was to establish, by means of peripheral quantitative computed tomography (pQCT) at the distal radius, the existence of cortical and/or trabecular osteopenia, and to assess the integrity of bone geometry in uremic patients undergoing maintenance hemodialysis. Our results show a clearcut selective reduction in volumetric cortical density, more evident in women (p = -0.0001) than men (p = 0.030), which appears to be independent of age and menopausal status. Trabecular density was not significantly changed in either sex. Cortical density of the patients correlated inversely with age (p = 0.003), duration of dialysis (p = 0.002) and parathyroid hormone (PTH) levels (p = 0.03). Trabecular density correlated only with age. Normally, cortical density is age-dependent and its reduction is accompanied by compensatory geometry changes. Compared with control subjects, in our female patients both cortical area and cortical thickness were reduced (p = 0.02 and 0.008), while cross-sectional area did not change (p = 0.67). Conversely, in the males only cross-sectional area was reduced (p = 0.02). In conclusion, in uremic patients we observed a selective cortical osteopenia, more evident in the female sex, and a sex-specific pattern of geometry impairment, with resultant apparent increased bone fragility in the uremic women. We suggest that the prolonged PTH excess could be responsible, directly and/or interacting with estrogen deficiency.

MeSH terms

  • Adult
  • Aged
  • Anthropometry
  • Bone Density*
  • Bone Diseases, Metabolic / diagnostic imaging
  • Bone Diseases, Metabolic / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Radius / diagnostic imaging
  • Radius / physiopathology
  • Renal Dialysis*
  • Time Factors
  • Tomography, X-Ray Computed
  • Uremia / complications*
  • Uremia / physiopathology
  • Uremia / therapy

Substances

  • Parathyroid Hormone