Geschlechtsspezifische Aspekte bei CKD-MBD – Frakturen, vaskuläre Kalzifikationen und die Bedeutung der Osteoporose

Störungen des Knochen- und Mineralstoffwechsels sind ein häufiges und schwerwiegendes Problem bei Dialysepatienten. Bei dialysepflichtigen Frauen sind eine erhöhte Frakturrate und schwere arterielle Kalzifikationen mit einer erhöhten Mortalität assoziiert. Eine sich frühzeitig manifestierende Osteoporose kann hier sowohl die Frakturursache als auch ein wesentlicher Faktor bei der Entstehung von vaskulären Kalzifikationen sein. Daher sollten der Diagnostik und Therapie einer Osteoporose bei Dialysepatienten eine besondere Bedeutung zukommen und durch klinische Forschung verbessert werden.

Mineral and bone disorder is a key problem in dialysis patients. Women on dialysis therapy showed an association between increased fracture rate, severe arterial calcification and high mortality. Premature osteoporosis seems to be a risk factor for bone fracture as well as for vascular calcification in female dialysis patients. Therefore, clinical studies are needed to evaluate reliable diagnostic and therapeutic tools for osteoporosis in the dialysis population.

Key words

mineral and bone metabolism - fractures - vascular calcification - osteoporosis

• Literatur

• 1 Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis 2004; 44: 672-679
• 2 Jadoul M, Albert JM, Akiba T et al. Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2006; 70: 1358-1366
• 3 Moe S, Drüeke T, Cunningham J et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006; 69: 1945-1953
• 4 Malluche HH, Mawad H, Monier-Faugere M. Renal osteodystrophy in the first decade of the new millennium: analysis of 630 bone biopsies in black and white patients. J Bone Miner Res 2011; 26: 1368-1376
• 5 Wood SL, Brown JE. Skeletal metastasis in renal cell carcinoma: Current and future management options. Cancer Treat Rev [Epub ahead of print] 28.07.2011; 14
• 6 Steward JH, Buccianti G, Agodoa L et al. Cancers of the kidney and urinary tract in patients on dialysis for end-stage renal disease: analysis of data from the United States, Europe, and Australia and New Zealand. J Am Soc Nephrol 2003; 14: 197-207
• 7 Nickolas TL, Leonard MB, Shane E. Chronic kidney disease and bone fracture: a growing concern. Kidney Int 2008; 74: 721-731
• 8 Jang C, Bell RJ, White VS et al. Women's health issues in haemodialysis patients. Med J Aust 2001; 175: 298-301
• 9 Huang GS, Chu TS, Lou MF et al. Factors associated with low bone mass in the hemodialysis patients--a cross-sectional correlation study. BMC Musculosceletal Disord 2009; 10: 60-60
• 10 Orlic L, Crncevic Z, Pavlovic D, Zaputovic L. Bone mineral densitometry in patients on hemodialysis: difference between genders and what to measure. Renal Failure 2010; 32: 300-308
• 11 Jamal SA. Bone mass measurement in men and women with chronic kidney disease. Curr Opin Nephrol Hypertens 2010; 19: 343-348
• 12 Braun J, Oldendorf M, Moshage W et al. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 1996; 27: 394-401
• 13 Nitta K. Vascular calcification in patients with chronic kidney disease. Ther Apher Dial 2011; 15: 513-521
• 14 Moe SM. Vascular calcification and renal osteodystrophy relationship in chronic kidney disease. Eur J Clin Invest 2006; 36 (Suppl. 02) 51-62
• 15 Rodriguez-Garcia M, Gomez-Alonso C, Naves-Diaz M et al. Vascular calcifications, vertebral fractures and mortality in haemodialysis patients. Nephrol Dial Transplant 2009; 24: 239-246
• 16 Alem AM, Sherrand DJ, Gillen DL et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 2000; 58: 396-399