INVESTIGADORES
COINTRY Gustavo Roberto
congresos y reuniones científicas
Título:
Biomechanical impact of chronic haemodialysis on bones and muscles. A pQCT study
Autor/es:
SARA FELDMAN; IRENE GRAPPIOLO; RICARDO FRANCISCO CAPOZZA; GUSTAVO ROBERTO COINTRY; GABRIEL INCHAUSPE; BEATRIZ RADICE; PAOLA REINA; SERGIO CASTELLINI; GRISELDA NICOLA; FAVIO ACOSTA; JOSÉ LUIS FERRETTI
Lugar:
Montreal (Canadá)
Reunión:
Congreso; XXX ANNUAL MEETING, American Society for Bone & Mineral Research (ASBMR); 2007
Resumen:
Biomechanical Impact of Chronic Haemodialysis (CHD) on Bones and Muscles. A pQCT Study   S. Feldman, I. Grappiolo, R. Capozza, G. Cointry, G. Inchauspe, B. Radice, P. Reina, P. Castellini, G. Nicola, F Acosta, J.L. Ferretti. Center of P-Ca Metabolism Studies (CEMFoC), Faculty of Medicine, Natl Univ of Rosario, Argentina.       This paper aims to describe the impact of CHD on the musculoskeletal system in men and women following biomechanical criteria. Tomographic (pQCT) indicators of bone mass (trabecular and cortical BMC -TbC, CtC-; trabecular vBMD -TbD-; cortical CSA -CtA-), tissue mineralization (cortical vBMD corrected from the partial-volume effect -CtD-), cross-sectional design (endosteal perimeter -EoPm-; cortical thickness -CtTh-; bending and torsion moments of inertia -CSMI’s-) and strength (Bone Strength Indices -BSI’s-; Stress-Strain Index -SSI-), and of muscle strength (height-adjusted muscle CSA, -mCSA-) were determined in tibial (4, 14, 38, and 66% sites) and radial (4 and 66% sites) scans of 21 men and 14 women aged 15-66 years under CHD. Z-scores of these data were calculated with reference to 260 healthy adults (60 men, 80 pre-MP women, 120 post-MP women) of comparable age. The pQCT data were correlated with serum PTH activity and time on dialysis (TOD).     Both CHD men and women showed significant impairments of TbC and TbD and less intense reductions of CtC, CtA, CtTh, BSIs and SSI. Bone mass loss was generally greater in women than men. EoPm was generally increased. A relatively mild impairment in CSMIs was observed, only significant in women. No changes were induced in CtD. The natural, hyperbolic relationships observed between CSMIs (y) and CtD (x) (“distribution/quality” curves, regarded as descriptive of the functional status of the bone mechanostat in the cortices) showed lower ordinates than normal only in the women. The mCSA was generally reduced, especially in the women. Bone mass (but not CSMIs) per unit of mCSA decayed, more severely in the women. The biomechanical changes in bone-muscle interactions were significant only in the tibial, not radial scans. All the described changes correlated significantly with both serum PTH and time on dialysis.     The CHD-induced osteopenia was more severe in metaphyseal regions with thin cortices than in diaphyses, and predominantly so in the women. As long as the cortical loss seemed to have resulted predominantly from endosteal resorption, its impact on the CSMIs was relatively mild, and cortical mineralization was rather kept unaltered. The mechanical orientation of bone modeling by bone mechanostat as a function of mechanical usage (CSMI/CtD ratio) was affected only in women, reflecting a metabolic (not mechanical) disturbance. Bone loss was associated to PTH activity and TOD in all patients, also suggesting a metabolic disturbance. Predominance of effects in the legs may be associated with stroll-related (i.e. mechanical) problems.