A New Method for the Assessment of Bone Mass in Renal Osteodystrophy

Torres, Armando; Benavent, Manuel Moya

doi:10.1159/000182468

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…TBBM has also previously been found to be reduced by 15-20% in uremic patients [ 18], though with a tendency for relative spinal preservation of bone mass. This con clusion is supported by a study using CT scanning of the lumbar spine [ 19] which found raised total bone mass in these patients, suggesting osteosclerosis. Total body cal cium determination using neutron activation analysis gives equivocal results [20][21][22], being generally normal or slightly raised compared to normals.…”

Section: Discussionsupporting

confidence: 56%

Noninvasive Diagnosis of Uremic Osteodystrophy: Uses and Limitations

Heaf¹,

Joffe²,

Pødenphant³

et al. 1987

Am J Nephrol

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45 bone biopsies from patients with chronic uremia were reviewed to define which noninvasive investigations were of value in predicting the histological diagnosis and to quantify the spectrum of uremic bone disease at a center that has consistently used an aluminum-free dialysis bath. 17 biopsies were taken postmortem. 15 patients received conservative treatment, the rest were on maintenance dialysis. 13 patients had symptomatic bone disease. Virtually all patients with a uremia duration greater than 3 years had uremic osteodystrophy. All patients with clinical bone disease, hypercalcemia or raised alkaline phosphatase activity had osteodystrophy, but the specific histology was not indicated. Greatly raised parathyroid levels suggested secondary hyperparathyroidism, but the test was only 100% specific when 20 times normal. Total aluminum consumption was highly indicative of bone aluminum concentration (p < 0.0001) and aluminum-related osteomalacia (5 cases), suggesting that a considerable proportion of uremic bone disease is iatrogenic. Serum aluminum was of some use in the diagnosis of aluminum-related osteomalacia, but was not wholly reliable. Bone mineral content (BMC) using both forearm measurements and total body bone mineral levels (TBBM) were assessed in 32 patients and were found to be reduced in 12, with a preponderance of secondary hyperparathyroidism. BMC and TBBM were negatively correlated to resorbing surfaces and bone formation rate, suggesting that secondary hyperparathyroidism is the uremic bone disease that represents the greatest threat to bone mass. It is concluded that while noninvasive investigations give considerable information, reliable diagnosis requires the use of histological methods.

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Section: Discussionsupporting

confidence: 56%

Noninvasive Diagnosis of Uremic Osteodystrophy: Uses and Limitations

Heaf¹,

Joffe²,

Pødenphant³

et al. 1987

Am J Nephrol

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“…Although total bone loss of 50-60% is the lower limit for detection by standard X-ray techniques [14], DEXA is capable of performing a noninvasive precise assessment of bone change and is thus a useful method to evaluate regional bone changes [1]. Mazess et al [7] reported that the BMD in HD patients was 20% lower than that of controls.…”

Section: Discussionmentioning

confidence: 99%

“…Facial nerve stimulation in response to activation of an electrode of a cochlear implant has been described, especially in patients with otosclerosis [8,14]. In these latter cases otospongiosis appears as foci of demineralization in the otic capsule [13].…”

Section: Introductionmentioning

confidence: 99%

Facial nerve stimulation by a cochlear implant in a hemodialysis patient with bone of low mineral density

Iwasaki

Atsumi

Ocho

et al. 1998

European Archives of Oto-Rhino-Laryngology

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Facial nerve stimulation by an activated cochlear implant was noted in a 56-year-old patient who had undergone cochlear implant with a Nucleus 22 implant 2 years previously as treatment for total sensorineural hearing loss following meningitis at age 54. Past history was complicated by total renal failure for which hemodialysis had been required during the past 13 years. Facial spasm occurred 5 months postoperatively with activation of the basal electrodes (channels 13 and 15 of the implant). The facial stimulation was eliminated by deprogramming these electrodes. High-resolusion computed tomography (CT) scanning was unable to demonstrate lucency of the otic capsule and cochlear ossification, but basal electrodes of the implant could be identified near the labyrinthine segment of the facial nerve. To further evaluate bone changes in the patient, the total and regional bone mineral density (BMD) of the head and radius was measured by dual energy X-ray absorptiometry. All BMD values of the patient were markedly low when compared to those of 62 other hemodialysis patient. These findings demonstrate that facial nerve stimulation can occur in the presence of low impedance due to cortical bone changes induced by long-term hemodialysis.

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“…An article of Torres and Moya in the M arch issue of your Journal [1] described a new method for determining bone mineral content in renal osteodystrophy by computerized tomography (CT). They emphasized the usefulness of eval uating trabecular bone mass for diagnosis of renal osteo dystrophy and for following the effects of any treatment given.…”

mentioning

confidence: 99%