■透析患者髋骨微结构的纵向变化和估计的骨强度,以及慢性肾脏疾病-矿物质和骨骼疾病(CKD-MBD)生物标志物对这些变化的影响,仍然没有充分的探索。
■这项回顾性研究检查了皮质和小梁骨隔室的变化以及估计的骨强度指数,通过使用3D-SHAPER软件获得,276名透析患者的髋部长达2.5年。我们使用多变量混合模型来研究时间依赖性CKD-MBD生物标志物与骨健康指标之间的关联。
■区域骨矿物质密度(aBMD)显着降低,积分体积BMD(vBMD),小梁vBMD,皮质厚度和皮质表面BMD(sBMD)。在估计的骨强度指数[横截面积(CSA)中发现了类似的恶化,横截面惯性矩(CSMI),截面模量(SM)和屈曲比]。血清钙和磷酸盐水平均与三维参数或估计的骨强度指数的变化无关。相比之下,血清碱性磷酸酶水平与aBMD和CSA呈显著负相关。完整甲状旁腺激素(i-PTH)与aBMD呈显著负相关,积分vBMD,小梁vBMD,皮质厚度,皮质vBMD,CSA,CSMI和SM。当应用KDIGO标准作为敏感性分析时,PTH较高组与aBMD呈显著负相关,积分vBMD,皮质vBMD,皮质厚度和皮质sBMD。值得注意的是,PTH较低组与整体vBMD和骨小梁vBMD呈显著正相关。
■高架PTH,不是低PTH,与髋骨微结构的恶化有关。更好地管理PTH水平可能在透析患者的髋骨微结构中起关键作用。
UNASSIGNED: The longitudinal changes in hip-bone microstructures and estimated bone strength in dialysis patients, and the impact of chronic kidney disease-mineral and bone disorder (CKD-MBD) biomarkers on these changes, remain insufficiently explored.
UNASSIGNED: This retrospective study examined changes in cortical and trabecular bone compartments and estimated bone-strength indices, obtained by using 3D-SHAPER software, in the hip regions of 276 dialysis patients over up to 2.5 years. We used multivariate mixed models to investigate the associations between time-dependent CKD-MBD biomarkers and bone health metrics.
UNASSIGNED: There was a significant decrease in areal bone mineral density (aBMD), integral volumetric BMD (vBMD), trabecular vBMD, cortical thickness and cortical surface BMD (sBMD). Similar deteriorations were found in estimated bone-strength indices [cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (SM) and buckling ratio]. Neither serum calcium nor phosphate levels were significantly associated with changes in three-dimensional parameters or estimated bone-strength indices. In contrast, serum alkaline phosphatase levels showed a significant inverse correlation with aBMD and CSA. The intact-parathyroid hormone (i-
PTH) was significantly inversely correlated with aBMD, integral vBMD, trabecular vBMD, cortical thickness, cortical vBMD, CSA, CSMI and SM. When applying the KDIGO criteria as a sensitivity analysis, the higher
PTH group had significant negative associations with aBMD, integral vBMD, cortical vBMD, cortical thickness and cortical sBMD. Notably, the lower
PTH group showed a positive significant correlation with integral vBMD and trabecular vBMD.
UNASSIGNED: Elevated
PTH, not low
PTH, was associated with deterioration of hip-bone microstructures. Better management of
PTH levels may play a crucial role in the hip-bone microstructure in dialysis patients.