Renal osteodystrophy is a universal complication of uremia. Renal failure patients are at risk for low bone mineral density (BMD) and fractures. Parathyroid hormone (PTH) plays a pivotal role in the pathophysiology of uremic bone disease. Histomorphometric studies suggest that the maintenance of PTH levels between two and four times the upper limit of normal is associated with the lowest prevalence of two common forms of osteodystrophy: osteitis fibrosa cystica and adynamic bone disease. The purpose of this study was to investigate whether the above recommendation for PTH levels in dialysis patients corresponds to a more optimal BMD with a special emphasis on diabetic versus nondiabetic subjects. Twenty-eight patients with chronic renal failure on hemodialysis underwent measurement of PTH levels, as well as BMD at the lumbar spine, hip, and forearm. They were divided into three groups based on the mean PTH level over the 5 years prior to having BMD measured. Osteoporosis was diagnosed in 55percent of men and 87percent of women on dialysis. Predictors of BMD were gender, duration on hemodialysis, and diabetes. Our study supports the histomorphometry-based studies suggesting that the maintenance of intact PTH levels two to four times the upper limit of normal may be associated with better skeletal health in uremic patients on hemodialysis, and that the diabetic subgroup is at particular risk for low BMD.ASAKA M, 1992, CLIN NEPHROL, V38, P149; Atsumi K, 1999, AM J KIDNEY DIS, V33, P287, DOI 10.1016-S0272-6386(99)70302-1; Barnas U, 2001, AM J KIDNEY DIS, V37, P1247, DOI 10.1053-ajkd.2001.24529; BIANCHI ML, 1992, BONE, V13, P225, DOI 10.1016-8756-3282(92)90201-7; Coco M, 2000, AM J KIDNEY DIS, V36, P1115, DOI 10.1053-ajkd.2000.19812; El-Hajj Fuleihan G, 2001, PEDIATRICS, V107, P1; Fletcher S, 1997, NEPHRON, V75, P412; Fuleihan GE, 1999, NEW ENGL J MED, V340, P1840, DOI 10.1056-NEJM199906103402316; GABAY C, 1993, AM J NEPHROL, V13, P115, DOI 10.1159-000168600; Gerakis A, 2000, J NEPHROL, V13, P437; GHANNAGEYARED MH, 2000, J BONE MINER RES, V15, P1856; Goodkin DA, 2003, J AM SOC NEPHROL, V14, P3270, DOI 10.1097-01.ASN.0000100127.54107.57; HERCZ G, 1993, KIDNEY INT, V44, P860, DOI 10.1038-ki.1993.323; HRUSKA KA, 1995, NEW ENGL J MED, V333, P166; HUI SL, 1988, J CLIN INVEST, V81, P1804, DOI 10.1172-JCI113523; KANIS JA, 1994, J BONE MINER RES, V9, P1137; MALLUCHE H, 1990, KIDNEY INT, V38, P193, DOI 10.1038-ki.1990.187; MALLUCHE HH, 1992, KIDNEY INT S38, V42, P62; Marshall D, 1996, BRIT MED J, V312, P1254; MELTON LJ, 1993, J BONE MINER RES, V8, P1227; MELTON LJ, 1992, J BONE MINER RES, V7, P1005; Nisbeth U, 1999, TRANSPLANTATION, V67, P1218, DOI 10.1097-00007890-199905150-00004; NISHITANI H, 1991, CONTRIB NEPHROL, V90, P223; PEI Y, 1993, KIDNEY INT, V44, P159, DOI 10.1038-ki.1993.226; QI QL, 1995, AM J KIDNEY DIS, V26, P622, DOI 10.1016-0272-6386(95)90599-5; QUARLES LD, 1992, J CLIN ENDOCR METAB, V75, P145, DOI 10.1210-jc.75.1.145; Rix M, 1999, KIDNEY INT, V56, P1084, DOI 10.1046-j.1523-1755.1999.00617.x; Sanchez MC, 2000, AM J KIDNEY DIS, V36, P953, DOI 10.1053-ajkd.2000.19093; Schwartz AV, 2001, J CLIN ENDOCR METAB, V86, P32, DOI 10.1210-jc.86.1.32; SHERRARD DJ, 1993, KIDNEY INT, V43, P436, DOI 10.1038-ki.1993.64; WANG M, 1995, AM J KIDNEY DIS, V26, P836, DOI 10.1016-0272-6386(95)90453-0; Weinstein RS, 2000, J BONE MINER RES, V15, P621, DOI 10.1359-jbmr.2000.15.4.62122252
