Bone mineral density in haemodialysis patients: A comparative study of dual-energy X-ray absorptiometry and quantitative ultrasound

Background. Quantitative ultrasound (QUS) of bone is a relatively new techn ique that appears to assess 'bone quality' in addition to bone mineral dens ity. The purpose of this study was to evaluate the diagnostic potential of QUS of calcaneum and to correlate it with dual energy X-ray absorptiometry (DEXA) in chronic haemodialysis patients. Methods. Broad-band ultrasound attenuation (BUA; dB/MHz) and speed of sound (SOS; m/s) of calcaneum and DEXA (g/cm(2)) measurements of the lumbar spin e and hip were made in 39 patients. The indices obtained by either method w ere compared with age-and sex-matched controls. Calcaneal measurements were correlated to DEXA and relevant clinical and biochemical data of patients. Results. BUA and SOS values were markedly reduced in dialysis patients comp ared to controls (59.1+/-13.8 vs 73.0+/-16.2 dB/MHz, P<0.001 and 1533+/-28 vs 1560+/-29 m/s, P=0.014 respectively). There was a moderate, but signific ant association between calcaneal parameters and DEXA (r = 0.32-0.53, P < 0 .05). Both BUA and SOS scores were inversely correlated with age (r = -0.69 , P < 0.001) and duration of menopause (r = -0.74, P < 0.01). Additionally, BUA values showed a moderate negative association with serum intact parath yroid values (r = -0.38, P = 0.018). Conclusion. Chronic haemodialysis patients have reduced calcaneal BUA and S OS scores. QUS of the calcaneum is an easy-to-apply and radiation-free tech nique. It could be a useful substitute for assessment of bone density in su ch patients. However, further studies in large patient groups and compariso ns with plasma markers of bone turnover and bone biopsy findings are needed to assess its potential place in the management of renal osteodystrophy.