ABSTRACT
Renal osteodystrophy is a multifactorial disorder of bone remodelling that develops in patients with chronic renal failure [CRF]. Biochemical markers of bone turnover have been proposed for the noninvasive diagnosis of renal osteodystrophy. The purpose of this study was to evaluate intact parathyroid hormone [iPTH] and some markers of bone disease in predialysis [preD] and haemodialysis [HD] CRF patients and correlate them with bone mineral density [BMD]. Several biochemical markers were measured in the serum of 74 CRF patients [38 preD patients and 36 patients on regular HD]. In addition, 30 healthy volunteers were included as controls. BMD of all patients was measured by means of calcaneal ultrasonography. BMD was measured by means of ultrasound. BMD was significantly decreased in both patient groups when compared with controls. Also, it was significantly lower in patients with osteoporosis than in those with osteopenia. iPTH, total alkaline phosphatase [ALP] and osteocalcin [OC] levels were significantly elevated in both patient groups when compared with controls. Ionized calcium [Ca[2+]], free carnitine and insulin-like growth factor-1 [IGF-1] levels were significantly decreased in patients compared with controls. There was a significant inverse correlation of BMD with iPTH, ALP and OC and a significant positive correlation with Ca[2+] and IGF-1 in HD patients. PreD patients showed significant inverse correlation of BMD with iPTH and ALP and significant positive correlation with Ca[2+]. The results of the present study suggested that ultrasound is a useful method for evaluating BMD and provides information about diverse regional skeletal changes in CRF patients. iPTH, ALP, OC and Ca[2+] can predict renal osteodystrophy in preD and HD CRF patients. PreD and HD CRF patients often have low serum concentrations of free carnitine and IGF-1