bone density test

[pamster42000]

Do units routinely do bone density tests on patients? My daughter never had one done and her bones became so fragile just standing up she would get fractures. A Dr. one time said he never had seen someone with such fragile bones. If it isn't done routinely, shouldn't it be?


Edited: Fixed spelling error in subject line - okarol/admin

[Chris]

Well from what I read and been told, dialysis/kidney failure can effect the bones, but my docs never checked and neither did my transplant center when the meds also cause bone problems. I started having problems and had a DXA scan and it is usually done every 2 years. I see a bone health specialist who has me on calcium, prescription dose of Vitamin A, and Actonel. However if on dialysis to much calcium is not good. I would look into taking your daughter to a doctor who specializes in bones/ osteoporosis. However, my nephrologist ordered the DXA scan and after getting the results referred me to the bone center of the hospital.

Good Luck

[okarol]

Jenna had her first bone density scan as part of her gynecological exam for her transplant evaluation when she was 18 years old. She gets one every year now. If needed, Jenna will be given medications to help prevent bone density loss.

[monrein]

It ought to be routine, usually yearly.  I take Actonel, calcium and vitamin D although they stopped the Actonel while I was on D.  On D, the phosphate needs to be watched closely because too high a level will cause bone issues.  I also do weights at the gym and walk on the treadmill to put pressure on my hips and spine.

[Deanne]

My gynecologist sent me for a bone density test a couple of years ago because I was on progestin and had been on a high dose of prednisone in the past. It showed osteoporosis so my neph put me on fosamax with the goal of rebuilding bone density before I reach ESRD.

[cariad]

Hi Pam,

I don't know about dialysis centers, but a nephrologist I saw recently told me that there was no point in sending me for a bone density test because "there is nothing we can do about it" until after a transplant. If this is true, then I suppose bone density tests would not be prescribed while on dialysis.

I really detested that doctor and do not trust her, so I would not be surprised to hear she was wrong. I am interested to read what others do to prevent osteoporosis while on dialysis. I know parathyroid hormone control is crucial, but I was told all of the standard osteoporosis drugs were not options for those in renal failure.

[aharris2]

Pam,

No, bone density testing is not routinely done on dialysis patients in the US (I believe it has something to do with Medicare not feeling it is necessary, not sure though.) This is not good. My strong sentiment is that osteoporosis, all too common in ESRD, jeopardizes the quality of life and perhaps even life itself for a dialysis patient. Everyone should find a way to get a bone scan.

Cariad,

Our experience is with osteoporosis as a consequence of elevated pth (secondary hyperparathyroidism). Something can absolutely be done about this!!! The pth can be controlled either with medication or surgery and the bones will then slowly but surely rebuild themselves even under some severe restrictions (my brother must keep his calcium on the low side of normal, doesn't use any of the osteoporosis medications, and cannot use any of the vitamin d analogs commonly used at dialysis for fear of triggering another bout of calciphylaxis but his bone density is improving)

Rolando has had two bone density tests a year apart. The first was prescribed by the neph and the second by the pcp.

[okarol]

1: Kidney Int. 2008 Sep;74(6):721-31. Epub 2008 Jun 18.Click here to read Links
    Chronic kidney disease and bone fracture: a growing concern.
    Nickolas TL, Leonard MB, Shane E.

    Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA. tln2001@columbia.edu

    Susceptibility to fracture is increased across the spectrum of chronic kidney disease (CKD). Moreover, fracture in patients with end-stage kidney disease (ESKD) results in significant excess mortality. The incidence and prevalence of CKD and ESKD are predicted to increase markedly over the coming decades in conjunction with the aging of the population. Given the high prevalence of both osteoporosis and CKD in older adults, it is of the utmost public health relevance to be able to assess fracture risk in this population. Dual-energy X-ray absorptiometry (DXA), which provides an areal measurement of bone mineral density (aBMD), is the clinical standard to predict fracture in individuals with postmenopausal or age-related osteoporosis. Unfortunately, DXA does not discriminate fracture status in patients with ESKD. This may be, in part, because excess parathyroid hormone (PTH) secretion may accompany declining kidney function. Chronic exposure to high PTH levels preferentially causes cortical bone loss, which may be partially offset by periosteal expansion. DXA can neither reliably detect changes in bone volume nor distinguish between trabecular and cortical bone. In addition, DXA measurements may be low, normal, or high in each of the major forms of renal osteodystrophy (ROD). Moreover, postmenopausal or age-related osteoporosis may also affect patients with CKD and ESKD. Currently, transiliac crest bone biopsy is the gold standard to diagnose ROD and osteoporosis in patients with significant kidney dysfunction. However, bone biopsy is an invasive procedure that requires time-consuming analyses. Therefore, there is great interest in developing non-invasive high-resolution imaging techniques that can improve fracture risk prediction for patients with CKD. In this paper, we review studies of fracture risk in the setting of ESKD and CKD, the pathophysiology of increased fracture risk in patients with kidney dysfunction, the utility of various imaging modalities in predicting fracture across the spectrum of CKD, and studies evaluating the use of bisphosphonates in patients with CKD.

http://www.ncbi.nlm.nih.gov/pubmed/18563052?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed

[Lucinda]

Hi Pamster

I have a fracture at the moment just from falling over a bucket of golf balls.  Calcium is vital as is Vitamin D.  I never break anything in the summer because I am a sunlover and spend eight hours a day out in it.  Come winter and my bones just seem to snap on their own.  Your daughter really should get a bone density test done once a year and up her caltrate and vitamin D if she needs to.  I joke about the breaks now while I am only 48 but what sort of mess am I going to be in when I am 60.  Really important to keep a check on it.