Streszczenia:
Ortopedia Traumatologia Rehabilitacja 2009, vol 11 (Suppl. 2), s:112.

 

University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania

Backround: Hypogonadism is associated with low bone mass, in men and women. ESRD is associated with a lot of hormonal effects on the hypothalamic-hypophisis-gonadic axes. We studied the relationship between hypogonadism and BMD, bone turnover and bone loss in patients with ESRD.

Methods Material: The study group comprised patients, diagnosed with secondary hyperparathyroidism, form all of the chronic hemodialised patients treated in the Haemodialysis and Renal Transplantation Center form the County Hospital nr.1. We diagnosed secondary hyperparathyroidism by means of repeated iPTH values (> 3xUNL), increased bone turnover markers. We also measured LH,FSH,PRL, Total testosterone and estradiol levels. Gynecological and urological evaluation were also done. BMD was meassured with DXA (anteroposterior technique, Delphi W device, Hologic Inc.).

Results: From the total of 66 (36 men, 30 women) cases with secondary hyperparathyroidism, with a mean age 44,32 years, beeing in the hemodialisis treatment for a perioad of 49,6 ± 43,72 months, 31 (46,9%) had hypononadism. 39% of men had secondary partial testosteron deficiency, 26,6% of the females had secondary amenoreea due to hyperprolactinemia and uremia, and 9 women were in natural menopause.

The risc of having bone demineralisation is higher in hypogonadal patientsal spine level (OR =1,038) or osteoporosis (OR = 3,98) compared with hip level (osteopenia: OR = 1,3, osteoporosis OR= 1,904)

Conclusion: Physiological or secondary hypogonadism impaires BMD in patients with secondary hyperparathyroidism. The effect is independent of age of the subject, BMI, or lenghts of hemodialisis.

Streszczenia:
Ortopedia Traumatologia Rehabilitacja 2009, vol 11 (Suppl. 2), s:122-123.

University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania

Backgound: ESRD is associated with reduce bone mineral density compared with aged-matched healthy controls. DXA is the standard noninvasive method to asses BMD. QUS is inexpensive, mobile, easy to perform, radiation free, recognize for screening abilities and risk fracture prediction in normal population. This study assessed the ability of QUS versus DXA in determine low bone mass in haemodialised population.

Methods Material Patients in the evidence of the Haemodialysis and Renal Transplantation Center form the County Hospital nr.1, performed DXA (anteroposterior technique, Delphi W device, Hologic Inc.), and also QUS (Sahara device, Hologic Inc.). Correlation between DXA and QUS parameters were performed. Receiver operator characteristic curves (ROC) were plotted for BUA, SOS and QUI and used to define cut-off values for best sensitivities and specificities for all parameter. WHO T score diagnosis of osteoporosis and osteopenia were used. We also used the UK NOS strategy to define the interval of the best QUS diagnostic parameter, to identify with 90% sensitivity and 90% specificity different degrees of bone demineralization.

Results: We analised 131 patients (63 females and 68 males), mean age 47,776±12, 32 years, being in haemodialysis for a mean period of mean 51,488±4,686 months. BUA (r = 0,613/0,447) and QUI (r = 0,613/0,502) seem to be the parameters of choice when considering BMD at cortical level. Areas under ROC for BUA and SOS in diagnosis of osteoporosis and osteopenia, have a sensibility of 76, 1%- 76, 1%, respectively a specificity of 72, 5%-77, 8%. The values for osteoporosis are even better, for 77% and 84%. The identified cutoff levels for QUI are 76,1 (osteopenia) and 69,6 (osteoporosis). The diagnostic value of QUS )when reporting QUI= are even higher when we did define the proper interval.

Conclusion: DXA and QUS parameters correlate significantly. The best QUS diagnostic parameter comoared to DXA is QUI. It has the ability to identify low bone mass (sensitivity of 60/80%), but also can discriminate very well the “healthy bone” subjects (specificity of 75%). Using the 90-90 approach, we identify the precise interval for QUI values that allows the best diagnostic of bone demineralization.