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Osteoporosis and Associated Risk Factors for Chronic Hemodialysis Patients
長期血液透析患者之骨質疏鬆症及危險因子
摘要
除了腎性骨失養症之外，骨質疏鬆症是長期透析患者另一種常見的骨病變，它們皆會使骨質密度降低，進而使骨折機率升高。目前流行病學研究已知許多危險因子與骨質疏鬆症的形成有關，但是透析患者的骨質疏鬆症與其危險因子的相關性，迄今為止尚未十分瞭解其相對之重要性，因此進行此研究來評估長期血液透析患者之骨質疏鬆症。我們對透析時間超過四個月的患者，使用雙能量X－光骨質密度儀進行腰椎及股骨頭的骨質密度測量，並從病歷紀錄蒐集實驗室數據及相關資料，然後用統計方去來分析骨質疏鬆症與這些危險因子之間的相關。我們總共有50位病患完成此研究，其中女性29名，男性21名，平均年齡53.7 ±10.2歲，我們根據世界衛生組織用雙能量X－光骨質密度儀之測量標準來定義骨質疏鬆症，發現我們透析患者中腰椎骨質疏鬆症有20名(40%)，股骨頭骨質疏鬆症有6名(12%)，而且腰椎骨質密度與股骨頭骨質密度有正向相關；我們用漸進性多元線性迴歸分析法來檢測多種潛在的危險因子與腰椎及股骨頭骨質密度的相關性，發現只有年齡及體重是影響骨質密度有達到統計學上意義的獨立因子，但是骨質密度與副甲狀腺荷爾蒙、血鈣、血磷、白蛋白、血紅素、Kt/V、骨頭鹼性磷酸鹽酶之間並無有意義相關。因此本研究結論為骨質疏鬆症在慢性血液透析患者中是很常見的，尤其是腰椎骨質疏鬆症更常見；年齡及體重是影響骨質密度有達到統計學上意義的獨立因子，但是並沒有發現副甲狀腺荷爾蒙與骨質密度下降有意義相關，因此我們認為慢性血液透析患者之骨質疏鬆症與副甲狀腺機能亢進引起之腎性骨失養症是無強烈的相關性。
並列摘要
In addition to renal osteodystrophy, osteoporosis is also frequently present in hemodialysis patients; both are responsible for a reduction in bone mineral density (BMD). Osteoporosis occurs in the general population secondary to multiple factors; however, little is known about the relative importance of these factors for hemodialysis patients. Hence, we conducted this study to evaluate osteoporosis for a number of chronic hemodialysis cases, with femoral neck and lumbar BMD measurement performed using dualenergy X-ray absorptiometry (DXA) where hemodialysis treatment had been in progress for longer than four months. Collection of laboratory data was performed by review of patient chart records, with statistical analysis used to identify the risk factors associated with osteoporosis. Evaluation was completed for a total of 50 patients (29 females, 21 males; mean age 53.7±l0.2 years), with 20 (40%) cases of lumbar osteoporosis, and 6 (12%) of femoral-neck osteoporosis from DXA measurements, as defined by the WHO. A positive correlation was demonstrated for femoral-neck BMD and lumbar BMD. Age and body weight were significant independent factors associated with BMD from multiple linear regression analysis. Further, there were no significant associations for BMD and intact PTH, calcium, phosphate, albumin, hemoglobin, Kt/V and alkaline phosphatase. In conclusion, osteoporosis is common for chronic hemodialysis patients, especially the lumbar variant, with age and body weight being important risk factors for BMD for these patients. The fact that no significant association was demonstrated for serum parathyroid hormone level and BMD in our study suggests that there is no strong relationship for osteoporosis and hyperparathyroidism induced renal osteodystrophy.