Bone Mineral Loss in Patients on Maintenance Hemodialysis with Hyperphosphatemia Treated with 1α-Hydroxycholecalciferol and Calcium Carbonate

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We investigated the relationship between bone mineral density loss and mean serum phosphate level for one year in 58 men on maintenance hemodialysis who were treated with 1α-hydroxycholecalciferol and calcium bicarbonate. Bone mineral density of the femur head and neck was measured twice, 8 months apart, by dual energy X-ray absorptiometry (Hologic QDR 1000). Patients were divided into two groups according to their mean serum phosphate level during the year of the study. Group A had almost normal serum phosphate levels (mean, <6.0 mg/dl) and group B had hyperphosphatemia (mean, ≥6.0 mg/dl). In group A, the mean bone mineral density was 0.825±0.122 g/cm2 at the beginning of the study and 0.828 ±0.118 g/cm2 8 months later. In group B, these values were 0.787 ±0.167 g/cm2 at the beginning and 0.762 ±0.171 g/cm2 8 months later. Bone mineral density did not decrease in group A, but it decreased significantly in group B (p<0.01). For all patients, the percent increase in the bone mineral density was inversely correlated with the mean serum phosphate value for the year of the study (r= -0.274, p<0.05). These results indicate the importance of serum phosphate control in patients on maintenance hemodialysis, even when they are being treated with 1α-hydroxycholecalciferol and calcium carbonate.
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