透析患者のＤＥＸＡによる骨密度測定の意義

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  • Clinical implications of measurement of bone mineral content by dual energy X-ray absorptiometry(DEXA).

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Of 195 dialysis (HD) patients (pts), 115 qualified for a study to investigate clinical correlations between duration of HD and bone mineral content, renal osteodystrophy (ROD), pain grade score and biochemistry. On the basis of duration of HD, the pts were divided into 4 groups. Group 1 consisted of 34 pts who had been on HD less than 5 years (yrs), group 2 of 37 pts on HD between 5 and 9 yrs, group 3 of 33 pts on HD between 10 and 14 yrs and group 4 of 11 pts on HD for 15 yrs or longer. Bone mineral density (BMD) of the metacarpals was measured by microdensitometry, and BMDS of the metacarpals, lumbar spine and femoral head were measured by DEXA.<br>Significant differences between the 4 groups were seen only in the metacarpals. There was a significant decrease in BMD in male pts who had been on HD for 10 or more years, whereas this decrease was already detected on female pts who had been on HD for less than 10 yrs. A positive correlation was noted between BMD of metacarpals and the ROD pain grade score in the 4 groups. According to the evaluation of BMD by DEXA in the previously mentioned bones, BMD of the metacarpals correlated most closely with ROD pain grade score, followed by duration of HD and age of the pts. Similary, lumbar spine correlated more with C-PTH than age of the pts. BMD of the femoral heads correlated, in decreasing order, with C-PTH, age of the pts, Ca and P product and calcitonin. Significant correlations were seen between BMD of metacarpals and duration of HD and ROD pain grade score.<br>Our data support earlier statements on the clinical importance of the use of microdensitometry and BMD of metacarpals by DEXA in evaluating ROD in HD. Study of the BMD of the lumbar spine by DEXA may indicate the effectiveness of HD therapy in long-term care for ROD.

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