| [ Summary ] |
Bone abnormalities in hemodialysis (HD) patients are totally different between diabetic and non-diabetic patients. Although serum PTH and the resultant bone turnover is suppressed, and thus bone mineral density is preserved in diabetic patients, compared with non-diabetic patients, bone fracture rate is significantly higher in diabetic patients than in non-diabetic counterparts. Although bone mineral density and bone turnover rate reflects risk for bone fracture in non-diabetic HD patients, in contrast to the lack of importance of these factors in bone fracture in diabetic patients. In the patients with high bone turnover disease, serum PTH and bone resorption markers provide relevant assays, while in low bone turnover disease, bone formation markers such as serum BAP and PINP may be useful. In monitoring the effect of vitamin D pulse therapy, the measurement of bio-intact PTH assay, which measures exclusively serum PTH (1-84) but not PTH (7-84), and bone resorption markers may be useful. |