Bone changes during hemodialysis — Relationship between bone x-ray findings and history or biochemical data

Abstract

In order to elucidate the pathogenesis of abnormal radiological findings of the bone in patients under hemodialysis, clinical course, blood biochemical data and degrees of bone loss, bone remodeling and bone metabolism were evaluated. Among 198 cases in which bone X-ray pictures were taken, renal osteodystrophy was found in 160 cases (81%). Bone remodeling assessed from X-ray pictures suggested increase of bone mass in 29 cases, decrease of bone mass in 131 cases and stable bone mass in 38 cases. High bone turnover was suggested in 72 cases, low bone turnover in 20 cases and intermediate bone turnover in 106 cases. After more than 50 months of hemodialysis, definite renal osteodystrophy appeared in the X-ray picture. The degrees of abnormalities of serum alkaline phosphatase, C-PTH and BGP were related to the duration of dialysis. Positive correlation was noted between ALP and degree of bone loss, and between C-PTH and BGP and rate of bone turnover. In patients with higher turnover bone with a decrease of bone mass and abnormalities of all these bone parameters, severe renal osteodystrophy with definite imbalance of bone metabolism was suspected.