[Assessment of geometric, biomechanical, and osteodensitometric properties of the ultradistal radius with peripheral quantitative computerized tomography in uremic patients with severe hyperparathyroidism]

INTRODUCTION: Bone integrity and mineral status were studied with a noninvasive method in uremic patients with severe secondary hyperparathyroidism undergoing maintenance hemodialysis. MATERIAL AND METHODS: Volumetric cortical and trabecular mineral density (cBMD, tBMD) and bone geometrical properties were evaluated in 16 patients (11 women and 5 men) candidate to parathyroidectomy. Peripheral quantitative Computed Tomography (pQCT) was used to make measurements at the distal radius of the nondominant forearm. Thirty-two age-matched healthy subjects were chosen as a control group. Cortical area (CA), cross-sectional area (Total A), cortical thickness (CThk) and stress strain index (SSI) were assessed as biomechanical parameters. Serum intact PTH levels were assessed with a radioimmunoassay method (IRMA). RESULTS: Both cBMD and tBMD were decreased in all patients and the difference was more significant in women (p < .0004 and p < .009) than in the smaller group of men (p < .01 and p < .01). Serum PTH levels correlated negatively with cBMD (r = .52; p < .01), CThk (r = .51; p < .04), CA (r = .52; p < .03) and SSI (r = .54; p < .02), as well as tBMD (r = .34), though not significantly. Dialysis duration did not significantly correlate with cBMD (r = .33), tBMD (r = .20), CA (r = .31), CThk (r = .40) and SSI (r = .35). As for geometrical and biomechanical parameters, CA, CThk and SSI were significantly different in both male and female uremic patients in comparison with the relative controls. Bone quantitative analysis and three-dimensional (3D) representation with the paraboloid revolution model also demonstrated osteopenia. CONCLUSIONS: pQCT shows significant cortical and trabecular osteopenia in uremic patients with severe secondary hyperparathyroidism. Osteopenia is associated with geometrical and mechanical impairment with consequently increased bone fragility and thus a higher risk of fracture. Prolonged PTH hyperexpression seems to be mainly associated with intracortical porosity and cortical-endosteal resorption. Bone quantitative analysis and 3D representation provide rapid automated information on the cortex mineral status