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PHOSPHORUS-CALCIUM BALANCE AND BONE MINERAL DENSITY OF DIFFERENT PARTS OF THE SKELETON IN CHRONIC HEMODIALYSIS PATIENTS

THE AIM of the work was to determine the relationship between the indices of phosphorus-calcium metabolism and bone mineral density (BMD) of different parts of the skeleton in patients on chronic hemodialysis. PATIENTS AND METHODS. Two-energy X-ray absorptiometry of 3 parts of the skeleton assessed by Z-criterion was used in 58 patients (m/f – 29/29, mean age 49.8 ± 13.3 years) treated by chronic bicarbonate hemodialysis (HD) on average for 74.3 ± 70.1 month. In addition to general clinical and laboratory indices in all the patients, the mean values of the level of intact parathyroid hormone (PTH) for the last year were taken into account, osteocalcin and C-telopeptides of the 1 type collagen (crosslaps) were determined in 38 patients. RESULTS. Mean values of BMD by Z-criterion in the lumbar vertebrae were (-0.35 ± 1.61), proximal part of the femur (-0.70 ± 1.16) and forearm (-1.15 ± 1.78) which is lower as compared with the vertebrae (t=2.51; p=0.013). BMD of the lumbar vertebrae was higher in patients with greater body mass (Rs=0.42; p=0.0012). BMD of the proximal part of the femur has a direct correlation with the patient’s body mass (Rs=0.57; p<0.001), product Ca x P (Rs=0.30; p= 0.031) and inversely – with the blood alkaline phosphatase level (APh; Rs= -0.28; p= 0.038). BMD of the forearm was lower in patients with longer HD (Rs=-0.49; p<0.001), high levels of PTH (Rs=-0.33; p= 0.017); APh (Rs=-0.56; p<0.001), C-telopeptides of the 1 type collagen (Rs=-0.53; p<0.001) and osteocalcin (Rs=-0.36; p=0.033). CONCLUSION. The forearm is the most sensitive area of the skeleton in patients to the influence of hyperparathyroidism. Lower BMD of the forearm is more pronounced in patients with long periods of hemodialysis therapy and the diagnosis of hyperparathyroidism.