[Relationship between renal function and bone mineral density in postmenopausal women that undergo bone mass evaluation]. / Relación entre función renal y densidad mineral ósea en mujeres posmenopáusicas que realizan evaluación de masa ósea.

As osteoporosis and renal insufficiency are two prevalent pathologies in the aging population we decided to evaluate retrospectively the renal function (estimated by formula) in postmenopausal women who came to our Institute for bone mass determination to establish the relationship between them. Thus, we studied 300 postmenopausal women with a mean age of 66.9 +/- 6.8 years who had a bone densitometry performed; we chose total femur bone mineral density (TFBMD) for defining osteopenia and osteoporosis as this measurement included substantial amounts of both trabecular and cortical bone; osteopenia/osteoporosis was diagnosed using T score criteria recommended by the WHO. We also measured BMD at the femoral neck. Renal function was estimated by the Cockcroft-Gault formula using serum creatinine determination. We found osteoporosis in 61 patients (20.3%). Of them, el 81.9% have renal insufficiency (estimated creatinine clearance-ECrC < or = 60 ml/min), compared to 54% of 239 women who had normal BMD/osteopenia (p < 0.001). Six of 61 (9.8%) women with osteoporosis had severe renal insufficiency (ECrC < or = 36 ml/min) versus 4/239 (1.6%) women with normal BMD/osteopenia (p = 0.001). Women with osteoporosis were older, and had a significantly lower weight and ECrC compared to patients without osteoporosis (ECrC 52 +/- 11 ml/min vs 59 +/- 12 ml/min; p < 0.0001). We found a significant positive correlation between TFBMD and ECrC (r = 0.389) as well as with weight (r = 0.422) and a negative correlation between age and ECrCE (r = -0.51) and with TFBMD (r = -0.22). In the multiple regression analysis only weight continued to correlate significantly with TFBMD (Beta = 0.344). When FNBMD was considered as the dependent variable, we found a significantly negative correlation with age (r = -0.30) and significantly positive correlations with height (r = 0. 16), weight (r = 0.33) and ECcr (r = 0.39). In the multiple regression analysis only age (Beta = -0.20) and weight (Beta = 0.20) continued having an independent correlation FNBMD. We conclude that our data confirm that there exists a substantial prevalence of renal insufficiency, even severe, among patients with densitometric osteoporosis that should be kept in mind when one is considering the prescription of medications as bisphosphonates that have renal clearance, so as not to jeopardize the efficacy and the security of these drugs.

Relación entre función renal y densidad mineral ósea en mujeres posmenopáusicas que realizan evaluación de masa ósea / Relationship between renal function and bone mineral density in postmenopausal women that undergo bone mass evaluation

Ya que la osteoporosis y la insuficiencia renal son dos patologías prevalentes en lapoblación que envejece quisimos evaluar en forma retrospectiva la función renal (estimadapor fórmula) en mujeres postmenopáusicas que concurrían a nuestro Institutopara evaluación de su masa ósea y establecer que tipo de relación existía entre lasmismas. Así estudiamos 300 mujeres postmenopáusicas con una edad promedio de66,9 ± 6,8 años a las que se les efectuó una densitometría ósea de cadera total(DMOCT) y cuello femoral (DMOCF); se diagnosticó osteoporosis sobre la base delos criterios de T score de la OMS. La función renal se estimó por fórmula de Cockcroft-Gault sobre la base de la medición de la creatinina sérica. Encontramos osteoporosisen cadera total en 61 pacientes (20,3%). De ellas, el 81,9% presentó insuficienciarenal (clearance de creatinina estimado —CcrE ≤ 60 mil/min), contra el 54%de 239 mujeres que presentaron DMO normal u osteopenia (p < 0,001). Seis de 61(9,8%) mujeres con osteoporosis presentaron insuficiencia renal severa (CcrE ≤ 36ml/min) contra 4/239 (1,6%) mujeres con DMOCT normal u osteopenia (p = 0,001).Las mujeres con osteoporosis fueron más añosas, y tuvieron un peso y un CcrE significativamentemenor que el de las pacientes sin osteoporosis (CcrE 52 ± 11 ml/minvs 59 ± 12 ml/min; p < 0,0001). Encontramos una correlación positiva significativaentre DMOCT y CcrE (r = 0,389) así como con el peso (r = 0,422) y una correlaciónnegativa entre la edad y CcrE (r = -0,51) y con la DMOCT (r = -0,22). En lacorrelación múltiple solo el peso continuó correlacionando en forma significativa conla DMOCT (Beta = 0,344). Cuando se consideró la DMOCF como la variable dependiente,encontramos una correlación negativa significativa con la edad (r = -0,30)y correlaciones significativas positivas con la talla (r = 0,16), con el peso (r = 0,33)y con el CcrE (r = 0,39). En el análisis de correlación múltiple solo la edad (Beta =-0,20) y el peso (Beta = 0,20) continuaron presentando una correlación significativaindependiente con la DMOCF. En conclusión, nuestros datos confirman que existe unasustancial prevalencia de insuficienica renal, incluso severa, entre las pacientes quepresentan osteoporosis densitométrica que debería ser tenida en consideración al decidirla prescripción de medicaciones que como los bisfosfonatos se eliminan por víareal, para no comprender la eficacia o la seguridad de estas drogas

As osteoporosis and renal insufficiency are two prevalent pathologies in the agingpopulation we decided to evaluate retrospectively the renal function (estimatedby formula) in postmenopausal women who came to our Institute for bone massdetermination to establish the relationship between them. Thus, we studied 300postmenopausal women with a mean age of 66.9 ± 6.8 years who had a bonedensitometry performed; we chose total femur bone mineral density (TFBMD) fordefining osteopenia and osteoporosis as this measurement included substantialamounts of both trabecular and cortical bone; osteopenia/osteoporosis was diagnosedusing T score criteria recommended by the WHO. We also measured BMDat the femoral neck. Renal function was estimated by the Cockcroft-Gault formulausing serum creatinine determination. We found osteoporosis in 61 patients(20.3%). Of them, el 81.9% have renal insufficiency (estimated creatinine clearance-ECrC ≤ 60 ml/min), compared to 54% of 239 women who had normalBMD/osteopenia (p < 0.001). Six of 61 (9.8%) women with osteoporosis had severerenal insufficiency (ECrC ≤ 36 ml/min) versus 4/239 (1.6%) women withnormal BMD/osteopenia (p = 0.001). Women with osteoporosis were older, andhad a significantly lower weight and ECrC compared to patients without osteoporosis(ECrC 52 ± 11 ml/min vs 59 ± 12 ml/min; p < 0.0001). We found a significantpositive correlation between TFBMD and ECrC (r = 0.389) as well as withweight (r = 0.422) and a negative correlation between age and ECrCE (r = -0.51)and with TFBMD (r = -0.22). In the multiple regression analysis only weight continuedto correlate significantly with TFBMD (Beta = 0.344). When FNBMD wasconsidered as the dependent variable, we found a significantly negative correlationwith age (r = -0.30) and significantly positive correlations with height (r =0.16), weight (r = 0.33) and ECcr (r = 0.39). In the multiple regression analysisonly age (Beta = -0.20) and weight (Beta = 0.20) continued having an independentcorrelation FNBMD. We conclude that our data confirm that there exists asubstantial prevalence of renal insufficiency, even severe, among patients with densitometricosteoporosis that should be kept in mind when one is considering theprescription of medications as bisphosphonates that have renal clearance, so asnot to jeopardize the efficacy and the security of these drugs

Relación entre función renal y densidad mineral ósea en mujeres posmenopáusicas que realizan evaluación de masa ósea / Relationship between renal function and bone mineral density in postmenopausal women

Ya que la osteoporosis y la insuficiencia renal son dos patologías prevalentes en la población que envejece quisimos evaluar en forma retrospectiva la función renal (estimada por fórmula) en mujeres postmenopáusicas que concurrían a nuestro Instituto para evaluación de su masa ósea y establecer que tipo de relación existía entre las mismas. Así estudiamos 300 mujeres postmenopáusicas con una edad promedio de 66,9 ± 6,8 años a las que se les efectuó una densitometría ósea de cadera total (DMOCT) y cuello femoral (DMOCF); se diagnosticó osteoporosis sobre la base de los criterios de T score de la OMS. La función renal se estimó por fórmula de Cockcroft- Gault sobre la base de la medición de la creatinina sérica. Encontramos osteoporosis en cadera total en 61 pacientes (20,3%). De ellas, el 81,9% presentó insuficiencia renal (clearance de creatinina estimado —CcrE <= 60 mil/min), contra el 54% de 239 mujeres que presentaron DMO normal u osteopenia (p < 0,001). Seis de 61 (9,8%) mujeres con osteoporosis presentaron insuficiencia renal severa (CcrE <= 36 ml/min) contra 4/239 (1,6%) mujeres con DMOCT normal u osteopenia (p = 0,001). Las mujeres con osteoporosis fueron más añosas, y tuvieron un peso y un CcrE significativamente menor que el de las pacientes sin osteoporosis (CcrE 52 ± 11 ml/min vs 59 ± 12 ml/min; p < 0,0001). Encontramos una correlación positiva significativa entre DMOCT y CcrE (r = 0,389) así como con el peso (r = 0,422) y una correlación negativa entre la edad y CcrE (r = -0,51) y con la DMOCT (r = -0,22). En la correlación múltiple solo el peso continuó correlacionando en forma significativa con la DMOCT (Beta = 0,344). Cuando se consideró la DMOCF como la variable dependiente, encontramos una correlación negativa significativa con la edad (r = -0,30) y correlaciones significativas positivas con la talla (r = 0,16), con el peso (r = 0,33) y con el CcrE (r = 0,39). En el análisis de correlación múltiple solo la edad (Beta = -0,20) y el peso (Beta = 0,20) continuaron presentando una correlación significativa independiente con la DMOCF. En conclusión, nuestros datos confirman que existe una sustancial prevalencia de insuficienica renal, incluso severa, entre las pacientes que presentan osteoporosis densitométrica que debería ser tenida en consideración al decidir la prescripción de medicaciones que como los bisfosfonatos se eliminan por vía real, para no comprender la eficacia o la seguridad de estas drogas

As osteoporosis and renal insufficiency are two prevalent pathologies in the aging population we decided to evaluate retrospectively the renal function (estimated by formula) in postmenopausal women who came to our Institute for bone mass determination to establish the relationship between them. Thus, we studied 300 postmenopausal women with a mean age of 66.9 ± 6.8 years who had a bone densitometry performed; we chose total femur bone mineral density (TFBMD) for defining osteopenia and osteoporosis as this measurement included substantial amounts of both trabecular and cortical bone; osteopenia/osteoporosis was diagnosed using T score criteria recommended by the WHO. We also measured BMD at the femoral neck. Renal function was estimated by the Cockcroft-Gault formula using serum creatinine determination. We found osteoporosis in 61 patients (20.3%). Of them, el 81.9% have renal insufficiency (estimated creatinine clearance- ECrC <= 60 ml/min), compared to 54% of 239 women who had normal BMD/osteopenia (p < 0.001). Six of 61 (9.8%) women with osteoporosis had severe renal insufficiency (ECrC <= 36 ml/min) versus 4/239 (1.6%) women with normal BMD/osteopenia (p = 0.001). Women with osteoporosis were older, and had a significantly lower weight and ECrC compared to patients without osteoporosis (ECrC 52 ± 11 ml/min vs 59 ± 12 ml/min; p < 0.0001). We found a significant positive correlation between TFBMD and ECrC (r = 0.389) as well as with weight (r = 0.422) and a negative correlation between age and ECrCE (r = -0.51) and with TFBMD (r = -0.22). In the multiple regression analysis only weight continued to correlate significantly with TFBMD (Beta = 0.344). When FNBMD was considered as the dependent variable, we found a significantly negative correlation with age (r = -0.30) and significantly positive correlations with height (r = 0.16), weight (r = 0.33) and ECcr (r = 0.39). In the multiple regression analysis only age (Beta = -0.20) and weight (Beta = 0.20) continued having an independent correlation FNBMD. We conclude that our data confirm that there exists a substantial prevalence of renal insufficiency, even severe, among patients with densitometric osteoporosis that should be kept in mind when one is considering the prescription of medications as bisphosphonates that have renal clearance, so as not to jeopardize the efficacy and the security of these drugs

Evaluation of cortical bone by peripheral quantitative computed tomography in renal transplant recipients.

BACKGROUND: The absolute risk of fractures in renal transplant patients is 3 times that of matched controls. Most of the symptomatic fractures are peripheral, suggesting a greater compromise of cortical bone. Peripheral quantitative computed tomography (pQCT) is a new imaging technique that allows separate noninvasive evaluations of cortical and trabecular bones. We investigated cortical bone by pQCT in 12 renal transplant patients (seven men and five women) for comparison with 27 normal controls. METHODS: pQCT (XCT 960, Stratec, Pforheim, Germany) was performed upon the distal radius of the nondominant forearm (15% the length of the ulna, proximal from the radius end plate). We evaluated total and cortical bone mineral density (TBMD, cBMD), total (cross-sectional) and cortical area (TA, cA), cortical thickness (cThk), endosteal and periosteal circumferences, and the buckling ratio (r/cThK). RESULTS: Compared with normal controls transplant patients as a whole showed a significant increase in TA, in endosteal circumference (P < .001), and in the buckling ratio (P < .001) with a significant reduction in cThK (P < .001). Female patients had a marked decrease in cA (51.4 vs 69.3 [pixel n]; P < .0001) and cThK (2.08 vs 2.78 mm; P < .0001). Male patients also had a decrease in cThK (2.54 vs 3.30 mm; P = .0001) and an increase in endosteal perimeter (31.2 vs 26.4 mm; P < .0001). Total time on dialysis prior to renal graft correlated negatively with cortical thickness (r = .62; P < .01). CONCLUSIONS: Our results suggest that a marked thinning of cortical bone may explain the increased incidence of peripheral fractures among renal transplant patients.