Comparative study of DEXA with biochemical bone markers in advanced CKD (stage 4 & 5) in diagnosis of osteoporosis

Abstract

Metabolic bone disease (BMD) is a common complication of chronic kidney disease and is a part of a broad spectrum of disorder of mineral metabolism and result in both skeletal and extra skeletal consequences. To reduce osteoporotic bone fracture early diagnosis of BMD is essential. This study aimed to observe osteoporosis by biochemical bone markers and DEXA. This cross-sectional observational study was conducted in the outpatient Department of Nephrology, Bangabandhu Shekhi Mujib Medical University, Dhaka and inpatient Department of Mymensingh Medical college, Mymensingh, from July 2017 to September 2018. Fifty-eight CKD (stage 4-5) patient confirmed by KDOQI guideline were selected. Parathyroid hormone was measured with a Beckman coulter Uncial DX! 800 devices using an immunoradiometric method. Serum calcium and Inorganic phosphate levels were measured employing routine laboratory procedures. Statistical analysis was done by using SPSS version 22.0. A value of p < 0.05 was considered statistically significant for all tests. Mean age of the patients was 46.71±7.73 years with a range of 29 – 63 years and male to female ratio was 1: 1.1. Stage 4 was 51.7% and stage 5 was 48.3%. Mean serum calcium, serum inorganic phosphate and parathyroid hormone was 8.19 ± 0.62 mg/dl, 5.18 ± 0.64mg/dl and 397.38 ± 221.24 pg/ml respectively. Mean BMD of lumbar spine, right femoral neck and left femoral neck was -2.22 ± 0.62, -2.10 ± 0.74 and -2.12 ± 0.71 respectively. There were significant differences in serum calcium, serum inorganic phosphate and parathyroid hormone among osteoporosis, osteopenia and normal BMD. Osteoporosis was higher in stage 5 patients. Osteoporosis was present in LS (39.7), FN right (37.9%) and in FN left (36.2%) in this study. DEXA can be used for diagnosis of osteoporosis in absence of bone biopsy. 

CBMJ 2026 July: Vol. 15 No. 02 P:267-275