The utility of FRAX® in predicting bone fractures in patients with chronic kidney disease on hemodialysis: a two-year prospective multicenter cohort study.

We assessed the FRAX® method in 718 hemodialyzed patients in estimating increased risk of bone major and hip fractures. Over two prospective years, statistical analysis showed that FRAX® enables a better assessment of bone major fracture risk in these patients than any of its components and other risk factors considered in the analysis. INTRODUCTION: Despite the generally increased risk of bone fractures among patients with end-stage renal disease, no prediction models for identifying individuals at particular risk have been developed to date. The goal of this prospective, multicenter observational study was to assess the usefulness of the FRAX® method in comparison to all its elements considered separately, selected factors associated with renal disease and the history of falls, in estimating increased risk of low-energy major bone and hip fractures in patients undergoing chronic hemodialysis. METHODS: The study included a total of 1068 hemodialysis patients, who were followed for 2 years, and finally, 718 of them were analyzed. The risk analysis included the Polish version of the FRAX® calculator (without bone mineral density), dialysis vintage, mineral metabolism disorders (serum calcium, phosphate, and parathyroid hormone), and the number of falls during the last year before the study. RESULTS: Over 2 years, low-energy 30 major bone fractures were diagnosed and 13 of hip fractures among them. Area under the curve for FRAX® was 0.76 (95% CI 0.69-0.84) for major fractures and 0.70 (95% CI 0.563-0.832) for hip fractures. The AUC for major bone fractures was significantly higher than for all elements of the FRAX® calculator. In logistic regression analysis FRAX® was the strongest independent risk factor of assessment of the major bone fracture risk. CONCLUSIONS: FRAX® enables a better assessment of major bone fracture risk in ESRD patients undergoing hemodialysis than any of its components and other risk factors considered in the analysis.

Quantitative ultrasound at hand phalanges in adults with end-stage renal failure.

The aim of this study was to assess bone status in 220 subjects with end-stage renal failure (ESRF) (146 men, mean age 53.0 +/- 13.9 years and 74 women, mean age 48.1 +/- 14.3 years). The duration of hemodialysis (durHD) and duration of renal insufficiency (durRI) were, in men, 2.6 +/- 3.8 years and 7.7 +/- 8.0 years, and, in women, 2.8 +/- 3.4 years and 9.1 +/- 7.6 years, respectively. ESRF was caused by the following reasons: chronic glomerulonephritis in 92 patients, diabetes in 52, chronic pyelonephritis in 37, polycystic kidney disease in 19, amyloidosis in 5, hypertension in 4 and unknown cause in 11. The control group consisted of 1615 normal healthy subjects (1216 women, mean age 48.1 +/- 12.1 years and 399 men, mean age 52.9 +/- 14.8 years). Mean age did not differ between patients and controls. Skeletal status was evaluated by quantitative ultrasound (US) measurements at the hand phalanges using DBM 1200 (IGEA, Italy) which measures amplitude-dependent speed of sound (Ad-SoS, m/s). The mean value of Ad-SoS in male patients was 1981 +/- 88 m/s, T-score -l2.03 +/- 1.26, Z-score -0.53 +/- 1.7 and, in female patients, 1967 +/- 96 m/s, -2.23 +/- 1.37, -1.41 +/- 1.56, respectively. Respective values in male controls were 2008 +/- 81 m/s, -1.66 +/- 1.16, -0.01 +/- 0.98 and, in female controls, 2026 +/- 81 m/s, -1.4 +/- 1.15, -0.74 +/- 0.86, and were significantly higher than in male (p < 0.001) and female (p < 0.0000001) patients. A correlation analysis of Ad-SoS with durHD and durRI showed that only in males did both factors significantly influence parameters measured (r = -0.26, p < 0.01). Multiple stepwise regression analysis of Ad-SoS on age, durHD, durRI, weight and height was possible to perform only in males and the following equation was established: Ad-SoS = 2545 m/s - 3.09 x age (years) - 5.68 x durHD (years) - 2.15 x height (cm) - 0.99 x durRI (years), p < 0.000001, r = 0.55, SEE = 69.6. Concluding, in subjects with ESRF treated with hemodialysis, skeletal status assessed with the use of quantitative US was affected.

Changes in bone density during long-term administration of low-molecular-weight heparins or acenocoumarol for secondary prophylaxis of venous thromboembolism.

BACKGROUND: Indications for long-term anticoagulation are expanding. Osteoporosis is a complication which can develop after prolonged treatment with unfractionated heparin and is probably multifactorial. Data on osteoporosis associated with low-molecular-weight heparins (LMWH) are contradictory. Vitamin K participates in bone metabolism and since oral anticoagulants antagonize vitamin K, their use may also increase the risk of osteoporosis. AIM: To assess and compare the effects of long-term secondary venous thromboembolic prophylaxis with LMWH or acenocoumarol on bone structure. METHODS: We assessed bone mineral density (BMD) by densitometry in 86 patients receiving LMWH or acenocoumarol for 3-24 months. The initial BMD was compared to the final result expressed as the percentage difference. The Z-score was also assessed and defined for individual patients as the number of standard deviations of BMD from its ideal value calculated for age and sex groups. RESULTS: Excessive decrease in BMD was evidenced, which seemed to relate to the duration as well as type of treatment. At 1 and 2 years of follow-up, the mean decrease in BMD of the femur was 1.8% and 2.6% in patients on acenocoumarol and 3.1 and 4.8% in patients on enoxaparin, respectively. CONCLUSIONS: Long-term exposure to treatment and prophylaxis of venous thromboembolism cause a modest but progressive decrease in BMD, more evident in patients on LMWH than on acenocoumarol. It might be advisable to perform densitometry before starting long-term anticoagulation and to repeat it every 12 months, especially in patients with concomitant risk factors for osteoporosis in order to identify patients in need of its prophylaxis.

Bone mineral density in adolescent girls with anorexia nervosa--a cross-sectional study.

UNLABELLED: The total body and lumbar spine bone mineral density (BMD) were measured in order to determine the prevalence and possible risk factors of decreased BMD in anorexia nervosa (AN). SUBJECTS: Sixty-one in-patient girls with DSM III-R AN: age 14.7+/-2.16 years; duration of AN 12.9+/-15.1 months; percentage of ideal body weight 70+/-8.7%; body mass index score -1.62+/-0.79. METHOD: Total body (in 61 patients) and lumbar spine BMD (in 43 patients), content of lean and fat tissue mass were measured by DXA during the first month of treatment. RESULTS: Low total body BMD was found in 23.7% and low lumbar spine BMD in 36.6% of patients. There was a negative correlation between BMD and age, age of menarche, degree of undernourishment, duration of AN and amenorrhea. A step-wise linear regression analysis revealed that age of menarche was the most important factor related to BMD in this group.

Imaging of bone in the diagnostics of renal osteodystrophy in children with chronic renal failure.

BACKGROUND: In the last two decades considerable advances have been made in the development of imaging tests of the skeletal system. This progress in diagnostic techniques, along with the growing availability of the tests, renders it necessary to review and evaluate their suitability for daily clinical practice. The aim of this article is to compare the results of radiological testing of bone with densitometrical, histomorphometric, and biochemical tests in children with chronic renal failure. MATERIAL AND METHODS: The research involved 31 children with renal failure, of whom 10 were being treated conservatively, 17 by continuous ambulatory peritoneal dialysis (CADO), and 4 by hemodialysis (HD). In all these children, radiological examinations of bone were performed in the arms, knees, and hips, along with tests for the serum concentration of parathormone (iPTH), calcium (Ca), and phosphates (P), and for the activity of alkaline phosphatase (AP). Bone density tests by the DXA method and bone biopsies were also performed. On the basis of radiological evaluation, the patients were divided into two groups: Group I, consisting of 14 children with a normal bone structure image, and Group II, consisting of 17 children with bone atrophy. RESULTS: No statistically significant differences were discovered in the mean values of the tested biochemical parameters between the two groups. The mineral density of total body was normal in 9 of the 14 patients in Group I (64%), and in 7 of 17 (41%) from Group II. The mineral density of total lumbar spine gave similar results. Lower bone density results were obtained in Group II than in Group I, though only in the case of the lumbar spine were the differences statistically significant. In Group I, 5 cases were discovered of chronic osteodystrophy without osteomalacia and hyperparathyroidism (NB), 2 cases of adynamic bone disease (ABD), 4 cases of hyperparathyroidism (HP), 2 cases of moderate hyperparathyroidism (MHP), and one mixed form (Mix); in Group II, there were 6 NBs, 2 ABDs, 1 case of osteomalacia (OM), 5 HPs, and 3 mixed. Radiological examinations revealed one male in Group I with features of prior Perthes's disease, one with fibrous cortical defect, and four cases of valgity of the coxa valga. In Group II, there were 3 children with radiological changes typical for osteomalacia, and in 1 case typical radiological signs of hyperparathyroidism. CONCLUSIONS: Given the lack of consistency in the results of the tests here presented, an entire panel of available tests should be performed for the comprehensive evaluation of the status of the skeleton.

Bone mineral content and bone mineral density in adolescent girls with anorexia nervosa--a longitudinal study.

OBJECTIVE: Total body and lumbar spine bone mineral density (BMD-TB, BMD-L) and total body bone mineral content (BMC-TB) were measured to establish the course of bone demineralization in anorexia nervosa and the clinical factors influencing BMC-TB and BMD changes during treatment. METHOD: Forty-two girls with DSM III-R anorexia nervosa, age 14.7+/-2.4 years. BMC-TB, BMD-TB and BMD-L were measured in approximately 7-month intervals for 27.8+/-4.1 months using DXA. RESULTS: Despite nutritional improvement, there was an initial decrease of BMD-L, and no change in BMC-TB and BMD-TB. an increase in BMC-TB and BMD was observed after approx. 21 months from the beginning of the study. CONCLUSION: The improvement in BMC-TB and BMD was related to changes in nutritional status and was significantly marked in younger patients, with earlier anorexia onset and before menarche.

[Bone mineral density in children with end-stage renal disease]. / Badanie gestosci kosci u dzieci ze schylkowa niewydolnoscia nerek.

The aim of the study was to evaluate bone mineralisation in comparison to chronological age, bone age and high age in children with end-stage renal disease. Fourty-four patients (16 female, 28 male) aged 7-16 years were examined. DXA bone densitometry of total body, bone age evaluated by Greulich-Pyle method and high age were performed in all patients. In our patients bone, and high age were significantly decreased in comparison to chronological age. In contrast mean value of Z-score TG BMD bone and high age compared to mean value of Z-score TB BMD for chronological age were increased significantly. We conclude that bone mineralisation should be compared with or high age not to chronological age in patients with end-stage renal disease.

[Risk factors of adynamic bone disease in children with end-stage renal failure: personal experience]. / Czynniki ryzyka adynamicznej choroby kosci u dzieci ze schylkowa niewydolnoscia nerek--doswiadczenia wlasne.

The aim of the study was to estimate predisposing factors which can cause adynamic bone disease (ABD) and biochemical markers, bone densitometry results, bone histomorphometry in 17 children with this from of the renal osteodystrophy. Half of these of patients were treated with alphacalcidol pulses. In 47% of patients hypercalcemic episodes were noted, 76% had PTH level < 50 pg/ml. Four patients with osteoporosis (low bone volume at histological analysis) were distinguished. Two of them were treated with corticosteroids, 1 was immobilized for a long time.

[Secondary anticoagulant prophylaxis with low molecular heparins or oral anticoagulants and bone mineral density]. / Wtórna profilaktyka przeciwzakrzepowa z uzyciem heparyn drobnoczasteczkowych lub doustnych antykoagulantów a mineralizacja kosci.

A broad spectrum of indications for low molecular weight heparin (LMWH) requires an assessment of side effects especially during prolonged administration. There are common risk factors for venous thromboembolism (VTE) and osteoporosis; heparin is "the drug of choice" for VTE treatment. The aim of our study was to assess the effect of treatment and prophylaxis with LMWH (enoxaparine sodium) and oral anticoagulant (acenocoumarol) for bone structure. Material consists of in- and outpatients. 49 densitometries were performed in 31 patients (in 15 cases double examination). We observed a decrease of bone mineral density in comparison to the initial examination in most cases: mean change of bone mass for examined areas was 3.05%.

[Hyperkalemic periodic muscle paralysis in primary adrenocortical insufficiency. A case report]. / Hiperkaliemiczne porazenie okresowe miesni w przebiegu pierwotnej niedoczynnosci kory nadnerczy opis przypadku.

20-years old man was admitted to the hospital because of a few paroxysmal muscle paralysis episodes with pronounced periodic hiperkalemia (maximal 9.8 mmol/l). The first episode was preceded by a very hard physical effort. Primary adrenal insufficiency was recognised on the basis of clinical, humoral and biochemical examinations. There was elevated ACTH and a very low serum level of cortisol and aldosterone. There was slight metabolic acidosis and hiponatremia. The patient was treated with hydrocortisone and fludrocortisone acetate (Cortineff) with positive result. During one year of this therapy his general condition was very good and clinical, humoral and biochemical signs (except of metabolic acidosis) resolved. Neurological symptoms and a very high serum kalium level were the most important signs of primary adrenal insufficiency in the presented case.

Quantitative ultrasound of phalanges and dual-energy X-ray absorptiometry of forearm and hand in patients with end-stage renal failure treated with dialysis.

The aim of the study was to evaluate the usefulness of quantitative ultrasound (QUS) measurement of the proximal phalanges of the hand in patients with end-stage renal failure (ESRF) treated with dialysis, and to compare results of this method with those from dual-energy X-ray absorptiometry (DXA) of hands and forearms (shaft and ultradistal site). Forty-one men aged 48.1 +/- 11.7 years and 31 women aged 43.1 +/- 12.3 years were examined. Mean QUS values of the hands in men and women with ESRF were significantly lower than the values of the healthy control group. There was a significant positive correlation between QUS and DXA of fingers, hands and also forearms, more pronounced in the shaft than in the ultradistal site. There was no significant difference in the measurements of extremities with or without a fistula. We conclude that QUS measurements are decreased in patients with ESRF treated with dialysis, and they correlate with DXA results. The simplicity of QUS makes it a valuable method in everyday practice. The clinical significance of the QUS results in these patients with ESRF treated with dialysis needs further investigation.

The benefits of hormone replacement therapy in pre-menopausal women with oestrogen deficiency on haemodialysis.

BACKGROUND: Impaired sexual function is an important cause of depression in uraemic females. Hyperprolactinaemia is frequent, and often associated with decreased serum oestradiol concentration, which can significantly contribute to accelerated bone loss. The aim of the study was to evaluate the effect of hormone replacement therapy (HRT) on sexual function, serum 17beta-oestradiol and prolactin, and bone mineral density (BMD) in pre-menopausal women undergoing haemodialysis. METHODS: Among 63 women on haemodialysis, aged 18-45 years, 23 with secondary amenorrhoea and serum oestradiol < 30 pg/ml were enrolled into the 1 year study. They were divided into: group I (n = 13) treated with transdermal oestradiol with cyclic addition of noretisterone acetate, and control group II (n = 10). BMD was measured with dual energy X-ray absorptiometry (DEXA). RESULTS: No important changes in sexual function and hormonal profile were observed in the control group, whereas in all women from group I the treatment induced regular menses and a marked improvement of libido and sexual activity. Serum 17beta-oestradiol increased after the first month from 20.5 +/- 11.7 to 46.8 +/- 13.6 pg/ml (P < 0.001) and remained at that level until the end of the study, accompanied by a decrease of serum prolactin (from 1457 +/- 1045 to 691 +/- 116 mIU/ml after 12 months; P < 0.001). In group I, the treatment induced an increase in BMD, although significant only in L2-L4 (P < 0.05), whereas in group II a mild insignificant decrease was observed. However, a comparison of BMD values after 12 months in both groups revealed marked (P < 0.01-P < 0.05) differences at all studied sites. CONCLUSIONS: Transdermal HRT allows sustained physiological serum oestradiol concentrations in pre-menopausal women with oestrogen deficiency on haemodialysis, with the restoration of regular menses and a marked improvement in their sexual function. The treatment inhibits bone demineralization and can play an important role in the prevention of early osteoporosis in this group of patients.

[The prevention of bone mineral loss with hormonal replacement therapy in premenopausal women on dialysis with estrogen deficiency]. / Hormonalna terapia zastepcza w zapobieganiu utracie mineralu kostnego u kobiet w wieku rozrodczym z niedoborem estradiolu leczonych powtarzanymi dializami pozaustrojowymi.

In 25-30% of premenopausal dialysis women low serum estrogen concentrations are observed. This "premature menopause" can significantly contribute to accelerated bone loss. The aim of the study was to evaluate the effect of estrogen-gestagen replacement therapy on bone mineral density (BMD) in hemodialysis women with secondary to uremia estrogen deficiency. Among 20 hemodialysis women, aged 18-45 years, with serum 17 beta-estradiol < 30 pg/ml, ten (group I) received transdermal estradiol with cyclic addition of noretisterone acetate (Estracomb TTS 50/0.25), and another ten formed the control group (group II). BMD was evaluated by dual photon x-ray absorptiometry (DEXA, Lunar) in: lumbar spine (L2-L4), 1/3 distal radius and femoral neck, before and after the study. Serum 17 beta-estradiol concentrations were measured before, and after 1, 3, 6 and 12 months of the study. After one year, in group I, in which serum 17 beta-estradiol normalized already during the first month (p < 0.001), an increase of in BMD was noted, although significant only in L2-L4 (p < 0.05). In group II, no change in serum 17 beta-estradiol and mild but insignificant decrease in BMD were observed. However, a comparison of BMD values after 12 months in both groups revealed the marked differences in all studied sites (p < 0.01, p < 0.02, p < 0.05 in L4-L2, distal radius and femoral neck, respectively). The mean serum calcium, phosphate, PTH and alkaline phosphatase activity were similar in both groups and did not change during the study. In premenopausal hemodialysis women with estrogen deficiency, hormonal replacement therapy inhibits bone demineralization and can be useful in prevention of early osteoporosis.

[Hormonal replacement therapy and lipid metabolism in women on hemodialysis with secondary to uremia estrogen deficiency]. / Hormonalna terapia zastepcza a gospodarka lipidowa u kobiet dializowanych z wtórnym do mocznicy niedoborem estrogenów.

UNLABELLED: It has been reported that postmenopausal women taking hormonal replacement therapy (HRT) are at reduced risk for cardiovascular disease mainly because of favorable changes in serum LDL- and HDL-cholesterol. However, the therapy is also known to increase hepatic triglyceride production. Cardiovascular events are the leading cause of death in patients on dialysis and lipid abnormalities are common. The aim of the study was to evaluate the influence of HRT on lipid metabolism in premenopausal women undergoing hemodialysis with premature oestrogen withdrawal. 25 hemodialyzed women, aged 37 +/- 9 years (19-44 years) with serum 17 beta-estradiol < 30 pg/ml were divided into: group I (n = 13) treated with transdermal HRT (estradiol with cyclic norethisterone acetate--Estracomb TTS 50/0.25; Novartis), and control group II (n = 12). Before the treatment serum LDL-cholesterol concentrations were increased in 24% and serum triglycerides in 40% of patients, whereas HDL-cholesterol was decreased in 72% of patients. During one year, in group I a noticeable, 15% increase in serum HDL-cholesterol was observed from 0.90 +/- 0.23 to 1.04 +/- 0.19 mmol/l (34.8 +/- 8.8 to 39.8 +/- 7.4 mg/100 ml; p < 0.01). It was parallel to the increase in serum 17 beta-estradiol concentrations (from 20.5 +/- 8.91 to 50.3 +/- 17.20 pg/ml; p < 0.01). Serum LDL-cholesterol and triglycerides did not change significantly. In the control group all those values remained unchanged. CONCLUSIONS: In hemodialysis women with premature estrogen deficiency the transdermal cyclic HRT leads to the clinically important increase in serum HDL-cholesterol without significant changes in serum triglyceride concentrations and could be beneficial in reducing cardiovascular risk in this population.

[Treatment of severe uremic hyperparathyroidism using a method for percutaneous injection of the parathyroid glands with ethanol]. / Leczenie ciezkiej mocznicowej nadczynnosci przytarczyc metoda przezskórnego ostrzykiwania gruczolaków alkoholem etylowym.

The results of recent studies suggest that uremic patients with large parathyroid hyperplasia are often resistant to active vitamin D3 therapy. Percutaneous ethanol injection has become an interesting option in such cases, although there are only a few publications on that subject. In this work we would like to present our experience with this method. 20 patients with serum iPTH > 400 pg/ml and 1-4 hyperplastic parathyroids (mean volume 1.07) underwent 56 percutaneous ethanol injection sessions under ultrasonographic guidance. In 9 patients a marked (> 75%), long-term (12-24 months) decrease in serum iPTH was achieved; lesser (> 50%) reduction in parathyroid activity persisted for 36-42 months in 5 out of 9 patients observed in this period. In almost every patient a significant reduction of alphacalcidol dose was possible. Our data confirm that percutaneous ethanol injection therapy is a useful and safe adjunct in severe uremic hyperparathyroidism treatment strategy which allows to restore the responsiveness to active vitamin D3 metabolites.

[Screening for renovascular hypertension in own material (1986-1998)]. / Badania przesiewowe nadcisnienia tetniczego naczyniowo-nerkowego w materiale wlasnym (1986-1998).

In 370 patients (pts) with hypertension(HT) in years 1986-1998 (168F + 202M, mean age 46 yrs) screening value of the following tests was evaluated: standard initial angioscintigraphy DTPA 99mTc(SA) in all pts(1-st screening group), significance of clinical suspicion on renovascular hypertension (RVHT) in the group of 74 pts (II-nd screening group). Captopril tests: renin captopril test(RCT) and isotopic captopril test (ICT) were performed in all 370 pts. Classical renal angiography as a reference test for renal artery stenosis (RAS) was performed in all pts suspected for RVHT on the basis of clinical anamnesis and or positive results of captopril tests. Results were as follows. Initial SA being abnormal in the whole group, appeared to be more significant for RAS only in the case of profound one side renal ischemia (GFR lower than 30% of total GFR). Resistance to three antihypertensive drugs, diastolic blood pressure > 120 mmHg and sudden onset of Ht, found in all 74 pts from the II-nd group, were the most significant clinical symptoms of RVHT, because critical RAS was found in 41, that is 55% of pts from the II-nd group. At least one positive CT was found in 37 from 42 pts with critical RAS in angiography with RTC being more sensitive and ICT more specific for hemodynamically significant RAS. The following screening protocol for RVHT was presented and discussed: precise clinical anamnesis followed by angiography or captopril tests according to the severity of clinical symptoms, aim of the study as well as accessibility and laboratory reproducibility of the captopril tests.

[Bone mineral disorders in patients with multiple myeloma]. / Zaburzenia mineralizacji kosci u chorych na szpiczaka mnogiego.

The aim of the study was to evaluate bone mineralization in the patients with multiple myeloma. The examinations were performed in 49 patients (25 men and 24 women). Seven patients were before chemotherapy and 42 patients were treated with chemotherapy. All of them received prednisone. The bone mineral density was measured by dual-energy X-ray absorptiometry with Lunar spine (L2-L4) in AP projection, femoral neck and total body were examined. There was a decrease of bone mineral density in 35 patients in at least one place (T-score more than 2 SD below normal of young healthy persons). There was no correlation between densitometric results and the duration of multiple myeloma, or chemotherapy. The decrease of bone mineral density (expressed es T-score) of lumbar spine (for the patients without spinal degenerative changes) was higher than that of femoral neck (p < 0.05). The decrease of bone mineral density (expressed as T-score) of lumbar spine and femoral neck was more pronounced than that of total body (p < 0.001). Bone densitometry, especially of lumbar spine and femoral neck and less of total body is indicated in the patients with multiple myeloma. The result of this examination may be considered as an independent parameter of disease intensity.

[Effect of calcitonin treatment on bone mineralization in patients with multiple myeloma]. / Wplyw leczenia kalcytonina na mineralizacje kosci u chorych na szpiczaka mnogiego.

The aim of the study was to evaluate the efficacy of half-year treatment of bone mineral disturbances with calcitonin in the patients with multiple myeloma. Thirty five patients (11 men and 24 women) were examined. They were treated among other with prednisone. Nineteen patients (15 patients with normal bone mineral density of lumbar spine and femoral neck and 4 with low bone mineral density who could not be treated with calcitonin) were treated only with chemotherapy. Other 16 patients with low bone mineral density have received also calcitonin (100 units subcutaneous daily) with vitamin D3 and calcium carbonate. Bone mineral density was evaluated with dual energy X-ray absorptiometry in lumbar spine and femoral neck. After treatment with calcitonin there was more pronounced influence on bone mineral density in lumbar spine and femoral neck than after treatment with chemotherapy only but the difference was not statistically significant. Because the bone mineral disturbances in the patients with multiple myeloma is the big problem there is a need for further and longer evaluation of the treatment of these disturbances.

Bone mineral density evaluated by dual-energy X-ray absorptiometry after one-year treatment with calcitriol started in the predialysis phase of chronic renal failure.

Thirteen patients in the predialysis phase of chronic renal failure (CRF) were treated with calcitriol (0.25 micrograms/day) and 12 with placebo. After 1 year of study, an increase in bone mineral density in the calcitriol group measured by dual-energy X-ray absorptiometry was seen for the femoral neck and lumbar spine when compared to the placebo group (p < 0.001 and p < 0.01, respectively). We conclude that a steady low dose of calcitriol started in the predialysis phase of CRF is beneficial to the patients with CRF. This may be partly due to suppression of secondary hyperparathyroidism.