| Popis: |
In order to determine risk factors for bone loss after renal transplantation, dual energy X-ray absorptiometry was performed in 125 renal transplant patients. The bone mineral density (BMD) was expressed as a percentage of the normal population (BMD%) and Z-score (SD from normal). The whole body, lumbar spine and femoral neck BMD% (Z-score) values were 93.9 +/- 8.9 (-0.90 SD), 91.6 +/- 14.9 (-0.98 SD) and 87 +/- 15.3 (-1.0 SD)%, respectively. Low BMD% was associated with low creatinine clearance (40 mL/min: 91.6 +/- 7.9,40 mL/min: 95.6 +/- 8.0, p0.01), repeated graft loss (0: 94.4 +/- 9.1,1: 87.4 +/- 9.3, p0.05), long dialysis duration (1 yr: 95.2 +/- 7.9,5: 90.1 +/- 10.6, p0.05), acidosis (bicarbonate21 mmol/L: 89.6 +/- 8.0,27: 96.7 +/- 7.2, p0.01), secondary and tertiary hyperparathyroidism (50 ng/L: 95.9 +/- 7.1,200: 87.7 +/- 5.0, p0.01), raised alkaline phosphatase (200 units/L: 95.7 +/- 7.2,300: 85.6 +/- 13.2, p0.001), osteocalcin (50 microg/L: 95.2 +/- 6.7,100: 89.3 +/- 7.6, p0.01) and urinary deoxypyridinoline (5 nM/mM creatinine: femoral neck 89.6 +/- 10.7,10: 82.1 +/- 20.1, p0.05), low 25-OH-vitamin D (10 microg/L: 91.3 +/- 9.8,20: 96.9 +/- 7.4, p0.001) and high cyclosporine concentration (0 ng/L: 98.3 +/- 7.0,150: 92.1 +/- 9.3, p0.05). Patients with clinical atherosclerosis (91.7 +/- 8.6 vs. 95.4 +/- 8.8, p0.01), hypoalbuminemia (550 micromol/L: 87.6 +/- 13.2,550: 94.2 +/- 7.8, p0.01), renovascular disease (89.7 +/- 5.7 vs. 95.0 +/- 5.7, p0.05) and diabetic nephropathy (femoral neck 76.6 +/- 8.8 vs. 89.3 +/- 15.1, p0.01) had lower bone masses. High bone mass was associated with previous dialysis alphacalcidol therapy (0: 92.2 +/- 7.5,3 microg/wk: 97.3 +/- 6.9, p0.05). No relationships with transplantation duration, 1,25-OH-vitamin D, aluminium, calcium or steroid dose were found. No involutional changes in tertiary hyperparathyroidism could be discerned.The major threats to bone mass after renal transplantation appear to be ongoing hyperparathyroid bone disease, low renal function, acidosis, systemic disease and hypo-vitaminosis D. |
