The role of dexa bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients

Johnson, D. W., McIntyre, H. D., Brown, A. and Freeman, J. (1996) The role of dexa bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients. Peritoneal Dialysis International, 16 1: 34-40.


Author Johnson, D. W.
McIntyre, H. D.
Brown, A.
Freeman, J.
Title The role of dexa bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 0896-8608
Publication date 1996-01
Sub-type Article (original research)
Volume 16
Issue 1
Start page 34
End page 40
Total pages 7
Place of publication Milton, ON, Canada
Publisher Multimed
Language eng
Formatted abstract
Objective: The aims of this study were to assess the clinical utility of total and regional bone densitometry in a large continuous ambulatory peritoneal dialysis (CAPD) population and to determine the clinical, biochemical, and radiographic variables that best identified osteopenic CAPD patients.

Design and Patients: A cross-sectional study was performed on 45 CAPD patients (19 males, 26 females), comprising the total CAPD population at the Princess Alexandra Hospital. Main Outcome Measures: Total body (TB), anteroposterior lumbar spine (APL), femoral neck (FN), Ward's triangle (WT), and skull bone mineral densities (BMDs) were measured using dual-energy x-ray absorptiometry (DEXA) and then correlated with clinical, biochemical, and radiographic indices of uremic osteodystrophy.

Results: BMDs were not significantly different from age- and sex-matched reference population data. Considerable regional variation of BMD Z scores were noted between FN (-0.11 ± 0.23), WT (-0.11 ± 0.22), and APL (1.22 ± 0.04) (p = 0.003). APLZ scores were significantly reduced in patients with a previous history of fracture (-1.36 ± 1.07 vs 0.89 ± 0.31), bone pain (-0.72 ± 1.08 vs 1.01 ± 0.31), or steroid treatment (-0.62 ± 0.39 vs 1.16 ± 0.35). Increased BMDZ scores for APL (1.82 ± 0.57 vs 0.38 ± 0.29, p < 0.05), FN (0.32 ± 0.36 vs -0.38 ± 0.29, p = 0.014), and WT (0.45 ± 0.38 vs -0.45 ± 0.26, p < 0.05) were found in patients with radiographic hyperparathyroid bone disease. Both APL BMD Z scores and skull BMDs were weakly correlated with PTH (r = -0.33, p < 0.05 and r = -0.33, p < 0.05, respectively) and with CAPD duration (r = 0.30, p < 0.05 and r = -0.30, p < 0.05). Generally, however, total body and regional BMDs were poorly related to age, renal disease type, dialysis duration, renal failure duration, serum aluminum, calcium, phosphate, alkaline phosphatase, osteocalcin, and parathyroid hormone.

Conclusions: We conclude that the prevalence of osteopenia is not increased in CAPD patients. Clinical and biochemical parameters do not reliably predict BMD measurements, but prior steroids and bone symptoms are major risk factors for important bone loss. Although DEXA can reliably detect osteopenia in different skeletal regions, its usefulness in detecting osteodystrophy is limited by the confounding effects of superimposed hyperparathyroid osteosclerosis, which increases BMD.
Keyword Bone mineral density
Dual-energy x-ray absorptiometry
Renal osteodystrophy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Wed, 09 Mar 2011, 14:25:51 EST