Ali Kemal KADİROGLU, Kenan TURGUTALP, Zulfikar YILMAZ, Dede ŞIT, İsmail Hamdi KARA, Hasan KAYABAŞI, Mehmet Emin YILMAZ

İki Yıllık Periodda Aktif Vitamin D Tedavisinden Sonra Paratiroid Hormone Düzeyine Göre Hemodiyaliz ve Devamlı Ayaktan Periton Diyaliz Tedavisi Gören Hastalarda Osteoporoz Sıklığı

Amaç: Osteoporoz; düşük kemik kitlesi, kemikte mikroyapısal dejenerasyon ve yüksek fraktürriskiyle karakterize bir iskelet hastalığıdır. Bu çalışmada amacımız iki yıllık periodda vitaminD tedavisinden sonra Paratiroid hormone düzeyine göre hemodiyaliz ve devamlı ayaktan peritondiyaliz tedavisi gören hastalarda osteoporoz sıklığını tespit etmektir.Materyal ve metod: Dicle Üniversitesi Tıp Fakültesi Hastanesi Diyaliz Merkezinde diyaliztedavisi gören 18 HD hastası (12 erkek, 6 kadın) ve 12 SAPD hastası (8 erkek, 4, kadın)çalışmaya alındı. Hastalar aktif vitamin D tedavisi öncesi ve sonrası sol topuk kantitatifultrasonografi ile ölçülen kemik mineral dansitesiyle değerlendirildi. Biyokimyasal analizleriçin kan örnekleri aktif vitamin D tedavisi öncesi ve sonrasında 12 saatlik açlık periodundansonra alındı. Bulgular: Tedavi sonunda kemik mineral dansitesinin T ve Z skorları ile ALP, PTH değeri 120-250 pg/ml olan grupla birlikte PTH değeri 250 pg/ml’den fazla olanlarda da yüksek bulundu.Bu değerler PTH değeri 120 pg/ml’nin altında olanlarda düşük bulundu. Başlangıç Osteoporozoranı; PTH değeri < 120 pg/ml olanlarda % 23, 120 -250 pg/ml olanlarda % 20 ve 250 pg/ml’denbüyük olanlarda ise % 20 olarak saptandı. Tedavi sonrasında sırasıyla % 30, % 0 ve % 20 olduğugörüldü.Sonuç: Tedavi öncesi T skor değerinde her üç grup arasında istatistiksel farklılık yoktu.Tedaviden sonra, anlamlı istatistiksel farklılık saptandı. Özellikle tedavi sonrası PTH değeri 120– 250 pg/ml olan ikinci grupta T skoru daha iyi bulundu

Anahtar Kelimeler:

PTH, osteoporoz, diyaliz, kemik mineral dansitesi

The Frequency of Osteoporosis in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients According to PTH Levels after Active Vitamin D Therapy during the Two Years Period

Aim: Osteoporosis is a skeletal disorder that is characterized by low bone mass, micro-structuraldegeneration of bone and high risk of fracture. In this study our aim was to detect the frequencyof osteoporosis in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)patients according to Parathyroid Hormone (PTH) after vitamin D therapy during the two yearsperiod.Materials and method: 18 HD patients (12 male, 6 female) and 12 CAPD patients (8 male, 4female) undergoing to dialysis therapy in dialysis center of Medicine Faculty Hospital in DicleUniversity were enrolled to the study. The patients were evaluated with bone mineral densitywhich was measured by left heel quantitative ultrasound before and after the active vitamin Dtherapy. The blood samples were collected for biochemical analysis in the morning after 12hours fasting period before and after the active vitamin D therapy. Results: After the therapy T and Z scores bone mineral density and ALP values were increasedin the group that PTH values were between 120-250 pg/ml and more than 250 pg/ml. But theseparameters were decreased in the group that PTH were lower than 120 pg/ml. Osteoporosispercentage were 23 % in PTH value 250 pg/ml in the initial measurement. After the therapy these were 30 %, 0% and 20 % relatively.Conclusion: Before the treatment there was not a statistical difference between T score of 3groups. After the treatment there was a statistically significant difference. Especially T scorewas better after the therapy in the second group that PTH values were between 120-250 pg/ml

Keywords:

PTH, osteoporosis, dialysis, bone mineral density (BMD),

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