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Decreased bone mineral density in diabetic patients on hemodialysis
1Second Department of Internal Medicine, Osaka City University Medical School, Japan.
Insights
Patients with diabetes undergoing hemodialysis (DM-HD) exhibit lower bone mineral density (BMD) compared to non-diabetic hemodialysis patients. Obesity is linked to higher head BMD in DM-HD patients.
Area of Science:
- Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Renal osteodystrophy presents distinct characteristics in diabetic patients undergoing hemodialysis (DM-HD) compared to non-diabetic hemodialysis (non-DM, HD) patients.
- Understanding these differences is crucial for managing bone health in this vulnerable population.
Purpose of the Study:
- To compare bone mineral density (BMD) between DM-HD and non-DM, HD patients.
- To identify factors influencing calcium metabolism and BMD in DM-HD patients.
Main Methods:
- Dual-energy X-ray absorptiometry (DEXA) was used to measure BMD in lumbar vertebra (L3), head, pelvis, and whole body.
- Clinical and biochemical parameters were compared between DM-HD patients with higher and lower head BMD.
Main Results:
- DM-HD patients demonstrated significantly lower BMD across multiple sites, including a notable difference in head BMD (p < 0.05).
- Higher head BMD in DM-HD patients correlated significantly with a greater degree of obesity (p < 0.005).
Conclusions:
- Diabetic status significantly impacts bone mineral density in hemodialysis patients.
- Obesity may play a protective role in maintaining head bone mineral density among DM-HD patients.
Abstract:
Renal osteodystrophy in hemodialyzed patients with DM-HD shows different features from that in non-DM,HD. Two studies were done. One was a comparison of BMD in 30 non-DM,HD patients and 30 DM-HD patients. The second was a comparison of possible factors affecting calcium metabolism in the higher and lower BMD groups (n = 20/21) in the DM-HD patients. BMD was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1,000/W) in the third lumbar vertebra (L3), head, pelvis, and whole body. The BMDs of the DM-HD group were lower in these areas and whole body than that in the non-DM,HD group. A significant difference was found in the head BMD (p less than 0.05). In the second study, factors which may contribute to the differences in BMD were compared in the DM-HD patients divided into higher and lower BMD of the head. The group with higher head BMD had a value 110% of the mean value or more. Clinical and biochemical test results (age, the time since the first dialysis, body weight, the degree of obesity, height, serum calcium, serum phosphate, serum aluminum, serum c-PTH level and the dose of 1 alpha-OH-D3) were compared. The degree of obesity of the patients with higher BMD was significantly larger than that with lower BMD (p less than 0.005).