Racial differences in bone mineral density and bone loss among end-stage renal disease patients

Although black patients without end-stage renal disease (ESRD) have a great er bone mineral density (BMD) than whites, the impact of race on BMD among patients with ESRD who are likely to have varying degrees of renal osteodys trophy is not known. We undertook a cohort study of 106 hemodialysis patien ts comparing BMD and bone loss between black and white patients with ESRD t o determine if black patients have a greater BMD and less bone loss than wh ite patients with ESRD. BMD was determined by dual-energy radiograph absorp tiometry (DEXA). Osteopenia was defined as greater than 1 standard deviatio n (SD) less than the mean of peak bone mass (T score < -1), and osteoporosi s was defined as greater than 2.5 SDs less than the mean of peak bone mass (T score < -2.5). The association between BMD and race was estimated using linear regression. The risk for osteopenia among black compared with white patients was calculated using logistic regression. Black patients were simi lar to white patients with respect to all characteristics noted, except bla ck patients were less likely to be men (69.7% v 49.4%) and tended to have g reater intact parathyroid hormone (PTH) values (mean, 403.2 +/- 384.5 pg/mL v 161.4 +/- 129.0 pg/mL), Compared with whites, the BMD of blacks was a me an of 1.15 (95% confidence interval [CI], 0.54 to 1.78) SDs greater at the femoral neck after adjusting for age, PTH level, and sex. The percentage of bone loss per year was similar between blacks and whites. The risk for ost eopenia among blacks was significantly less than that among whites (odds ra tio = 0.15; 95% CI, 0.04 to 0.59) after adjusting for age, sex, and PTH lev el. Black patients with ESRD have a greater BMD and are at decreased risk f or osteopenia compared with whites, independent of renal osteodystrophy. Wh en considering bone disease among patients with ESRD, physicians should als o consider osteoporosis acid the impact of race on BMD. (C) 1999 by the Nat ional Kidney Foundation, Inc.