ABSTRACT
Osteoporosis is often referred to as the "silent epidemic," it is a global problem that is increasing in significance as the population of the world both increases and ages. It is the most prevalent bone disorder in the general population, particularly in the middle and older age groups. Although more than half of the prevalent dialysis population is within these age groups, little concern has been given to the possible role of estrogen deficiency in the pathogenesis of bone disease in end stage renal disease [ESRD]. The purpose of this study is to evaluate both estradiol [E2] and parathormone [iPTH] as evidence that supports a potential role of the postmenopausal state in the pathogenesis of bone disease in ESRD to search for treatment. A total of 20 women below 50 years and had persistent amenorrhea with ESRD [under prolonged hemodialysis] were selected from Faysal Kidney Dialysis Unit Giza, Egypt [ESRD group] and a control group of 20 women matched with same age were selected from the healthy volunteers of the medical staffs. For all subjects, bone mass density [BMD] analysis by dual x-ray absorptiometry [DEXA] was done. Routine chemistry as serum creatinine, calcium, inorganic phosphorus and alkaline phosphatase were estimated using chemistry autoanalyzer. Serum E2 and iPTH levels were also measured by enhanced chemiluminescnce technique. It was shown that although the risk factors for fracture in ESRD were similar to the general population, the incidence was four folds higher in our cases. In ESRD cases the lower E2 level, the higher iPTH level [r=-0.861; p<0.001], and consequently the higher incidence of osteoporosis and fractures. Recent evidence on the risk of HRT therapy should caution about its use in ESRD patients. In conclusion, osteoporosis should be recognized as an important entity that may modify the current conception of renal osteodystrophy in postmenopausal patients with ESRD. Low serum E2 and high iPTH levels are risk factors in decreased BMD in postmenopausal women on dialysis. Early detection of osteoporosis leads to good prevention of the disease. The use of selective estrogen receptor modulators [SERM] which may increase bone mass without significant secondary effects needs further clinical studies in order to propose strategies that may reduce postmenopausal osteoporosis in the dialysis population and may be an essential part of post-renal-transplant care