بررسی تراکم استخوان در بیماران با نارسایی کلیه قبل و بعد از پیوند کلیه

نوع مقاله: مقاله پژوهشی

نویسندگان

1 اســتاد نفرولــوژی دانــشگاه علــوم پزشــکی مشهد، مشهد، ایران

2 اســـتادیار نفرولـــوژی دانـــشگاه علـــوم پزشکی مشهد، مشهد، ایران

3 دانشیارروماتولوژی دانـشگاه علـوم پزشـکی مشهد، مشهد، ایران

4 متخصص داخلی، مشهد، ایران

5 استادیار روماتولوژی دانشگاه علوم پزشکی مشهد، مشهد، ایران

چکیده

مقدمه
یکی از شایعترین عوارض متابولیک پیوند کلیه، کاهش تـراکم اسـتخوانی خـصوصا " در ابتـدای پیونـد مـی باشـد .
تشخیص به موقع و درمان آن در ابتدای پیوند می تواند مانع از بروز شکستگی و بـدتر شـدن آن بـه دنبـال مـصرف
کورتیکواستروئید باشد.
روش کار
این پژوهش یک مطالعه توصیفی بوده و به صورت مقطعی در فروردین تا مهر ماه 1385 در دانشگاه علوم پزشـکی
مشهد انجام شده است، 50 بیمار که در طی دوره مطالعه گرافت دریافت کرده بودند وارد مطالعه شدند و31 نفرآن
را به اتمام رسانیدند. این بیماران از لحاظ تراکم استخوانی بلافاصله قبـل پیونـد، 6 مـاه و1 سـال پـس از آن توسـط
روش جذب سنجی دوگانه اشعه ایکس ارزیابی شدند . اطلاعات بدست آمده در نرم افزار SPSS تجزیه و تحلیـل
شد و از آزمون های آماری دوگانه و کای دو و آنالیز واریانس نیز استفاده شد.
نتایج
از 31 نفر 17 نفر زن (54/8%) و 14 نفر مرد (45/2%) بودند. قبل از پیوند متوسـط تـی اسـکوئر در گـردن فمـور و
ستون فقرات کمری به ترتیب 0/88±1/19- و 0/37±1/12- بود. در ماه ششم پس از پیونـد، متوسـط آن درگـردن
فمور و ستون فقرات کمری به ترتیب به 1/42±0/95- و 1/41±1/36- کـاهش یافـت (p> 0/05). در پایـان سـال
اول، متوسط تی اسکوئر، در این مناطق معادل 1/13±1/11- و1/29±1/33- بود که نـسبت بـه نوبـت قبـل کـاهش
.(p> 0/05) نداشت بارزی
نتیجه گیری
کاهش تراکم استخوان در بعد از پیوند کلیه بیشتر در 6 مـاه ابتـدای پیونـد رخ مـی دهـد . لـذا بهتـر اسـت اقـدامات
پیشگیری و درمانی از ابتدای پیوند ویا حتی قبل ازآن آغاز شود. 

کلیدواژه‌ها


عنوان مقاله [English]

Assessment of Bone Density in Patients before and after Kidney Transplantation

نویسندگان [English]

  • Mohammad Javad Mojahedi 1
  • Farzaneh Sharifipour 2
  • Maryam Hami 2
  • Masoud Saghafi 3
  • Bita Dadpour 4
  • Nayereh Saadati 5
1 Professor of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran
2 Assistant Professor of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran
3 Associated Professor of Rheumatology, Mashhad University of Medical Sciences, Mashhad, Iran
4 Specialist in internal diseases (internist), Mashhad University of Medical Sciences, Mashhad, Iran
5 Assistant Professor of Rheumatology, Mashhad University of Medical Sciences, Mashhad, Iran
چکیده [English]

Introduction
Accentuation of bone loss is one of the most important skeletal complications after transplantation. Early diagnosis and treatment of osteopenia and osteoporosis reduce risk of fractures and prevent the aggravation of it by using corticosteroid after kidney transplantation.
Materials and Methods
A total of 50 patients that received graft during the research time, 31 of them completed it. They were screened for decreased bone mineral density at baseline, 6 and 12 months after transplantation with dual-energy x-ray absorptiometry (DEXA) of lumbar spine and hip.
Results
A total of 31 patients [17 (55.8%) female and 14 (45.2%) male] with end stage renal disease entered the study. The mean age of patients in both genders were 39.67±14.5 years (range: 20-67years). Replacement therapy in 24 patients (77.4%) was hemodialysis and in 7 patients (22.6%) was peritoneal dialysis. Before transplantation, the mean of T-score in femoral neck and lumbar vertebra were -0.88±1.19 and-0.37±1.12 respectively, osteopenia was found in 41.9% and 29% of each region. On 6 months after transplantation, the mean of T-score in femoral neck and lumbar vertebra -1.42±0.95 and -1.41±1.36 respectively. Incidence of osteopenia in each region was 83.9% and 64.5% in turn. We tried to examine them in the first year after transplantation, the mean of T-score in femoral neck was-1.13±1.11 and in lumbar vertebra was -1.29±1.33. After 6 months, bone mass reduction was significant (p<0.05), but there was not any significant difference between 6 and 12 months following transplantation (p>0.05).
Conclusion
Bone losswas highest in the first 6 months after transplantation. Then, treatment was necessary during this period of time.

کلیدواژه‌ها [English]

  • Bone densitometry
  • Renal transplantation
  • Osteopenia
  • Osteoporosis
1-Palmer SC, Mc Gregor OD. Evaluation and management of bone disease following renal transplantation. Curr Opin
Organ Transplant 2006; 11:407-412.
2-Casez JP, Lippuner K, Horber F, Montandon A, Jeager P. Changes in bone mineral density over 18 months following
kidney transplantation: the respective roles of prednisone and parathyroid hormone. Nephrol Dial Transplant 2002;
17:1318-1326.
3-Goodman WG, Coburn JW, Slatopolsky E, Salysky IB, Quarles LD. Renal osteodystrophy in adults and children. In:
Favus MJ. editor. Primer on metabolic Bone Diease and Disorder of Mineral Metabolism. 5th ed. Washington DC:
American Society for Bone Mineral Research; 2003.p.430-447.
4-Tanimi, Siniflamasi, Klingia. Assessment of fracture risk and its application to screening for postmenoposal
osteoporosis. Report of a WHO study Group. World health organ Techn. Rep Ser 1994; 843:1-129.
5-Sezar S, Ozdemir FN, Ibis A, Sayin B, Haberal M. Risk factors for osteoporosis in young renal transplant recipients.
Transplant proc 2005; 37:3116-3118.
6-Epstein S. Post-transplantation bone disease: The role of immunosuppressive agents and the skeleton. J Bone Miner
Res 1996; 11:1-7.
7-Tokumoto T, Tanabe K, Toma H, Akiba T. Treatment of bone disease in chronic kidney disease and in renal
transplant recipients under K/ DOQI clinical practice guidelines. Clin Calcium 2004; 14:10-18.
8- Cohen A, Shane E. Osteoprosis after solid organ and bone marrow transplantation. Osteoporos Into 2003; 14:617-630.
9-Cohen A, Ebeling P, Sprague S, Shane E. Transplantation osteoporosis. In: Favus MJ. editor. Primer on metabolic
Bone Diease and Disorder of Mineral Metabolism. 5th ed. Washington DC: American Society for Bone Mineral
Research; 2003.p.370-379.
10- Rodino MA, Shane E. Osteoprosis after organ transplantation. Am J Med 1998; 104:459-469.
11- Goodman GR, Dissamayake JR, Sodam BR, Gorodetsky E, Lu J, Ma YF, et al. Immunosuppressent use without
bone loss-implications for bone loss after transplantation. J Bone Miner Res 2001; 16:72-78.
12- Sperschneider H, Stein G. Bone disease after renal transplantation. Nephrol Dial Transplant 2003; 18:874-877.
13- Deseraux RG, Hoitsma AJ, Van Hoof HJ, Corstens FJ, Wetzels JF. Abnormal vitamin D metabolism and loss of
bone mass after renal transplantation. Neph J 2003; 93:C21-8.
14- Wong HS, Chau KF, Wong KM, Chan YH, Liu YL, Chan HW, et al. Prevalence of osteoporosis in patients after
prnal transplantation: results from a Single Center. Hong Kong J Nephrol 2005; 7:70-76.
15- Cunningham J. Post transplantation Bone Disease. Transplantation 2005; 79: 629-634.
16- Talalaj M, Gradowska L, Marcinowska-suchowierska E, Durlik M. Efficiency of preventive treatment of
glucocorticoid- induced osteoporosis with 25-hydroxy vitamin D3 and calcium in kidney transplant patients. Transplant
Proc 1996; 28:3485-3487.
17- Van Cleemput J, Daenen W, Geusens P, Dequcker P. Prevention of bone loss in cardiac transplant recipients. A
comparison of bisphosphonate and vitamin D. Transplantation 1996; 61:1495-1499.
18- Torres A, Garcia S, Gomez A, Gonzales A. Treatment with intermittent calcitriol and calcium reduces bone loss
after renal transplantation. Kidney Int 2004; 65:705-712.
19- Henderson K, Eisman J, Keogh A, MacDonald P, Glanville A, Spratt P, Sambrook P. Protective effect of short-term
calcitriol or cyclical etidronate on bone loss after cardiac orlung transplantation. J Bone Miner Res 2001; 16: 365-371.
20- Bianda T, Linka A, Junga G, Brunner H, Steinert H, Kiowski W. Prevention of osteoporosis in heart transplant
recipients: A comparison of calcitriol with calcitonin and pamidronate. Calcif Tissue Int 2000; 67:116-121.
21- Braith RW, Magyari PM, Fulton MN, Aranda J, Walker T, Hill JA. Resistance exercise training and Alendronate reverse
Glucocorticoids-induced osteoporosis in heart transplant recipients. J Heart Lung transplant 2003; 22:1052-1090.