Amount of Bone and Bone Remodelling in Normal Subjects and in Patients with Chronic Renal Failure

Abstract

Quantitative radiologic measurements of the second left metacarpal bone were performed on 63 normal men and 71 normal women, 105 patients with non-dialyzed chronic renal failure and on 32 chronic hemodialyzed men and women. For prospective analysis 42 non-dialyzed patients and 31 patients on chronic hemodialysis were available. Measurements of the total width, medullary cavity and combined cortical thickness at the midshaft of the metacarpal bone were made on postero-anterior hand radiographs with a readout of 0.1 mm using a direct reading needle-tipped calliper. Hereafter the cortical area and metacarpal bone mass were calculated. Mean values of the various parameters in the patient groups were compared with mean values of age-matched normal controls. For the prospective analysis the calculated, yearly change of the various parameters during the observation period were compared with the yearly change in normal persons, being estimated by regression analysis between age and radiologic values. Measurements of the amount of bone in normals and in patients with chronic renal failure were reliable, the intraobserver variation coefficient varying from 0.7 to 2.5 per cent and the interobserver variation coefficient from 1.0 to 5.8 per cent. Changes in thickness of the soft tissue of the hand only slightly affected the values, a change of 10 mm resulted in a change of one per cent of the measured and calculated values. Metacarpal bone mass was significantly reduced in normal men and women older than 50 years of age compared with younger persons. In older women, a significant yearly increase in the width of the bone marrow cavity occurred compared with younger women, reflecting a significant loss of cortical thickness, cortical area and metacarpal bone mass. In patients with chronic renal failure, a marked and, compared with normal control persons, significant bone loss with time occurred. In non-dialyzed men and hemodialyzed women this was probably due to a higher endosteal bone resorption than bone formation and in hemodialyzed men and non-dialyzed women, due to a higher resorption than formation both at the periosteal and endosteal surfaces.

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