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Keywords:

  • bone mineral density;
  • chronic kidney disease;
  • diabetes;
  • osteopaenia

Abstract

Objective  We investigated whether loss of bone is detectable during follow-up of diabetic patients with chronic kidney disease (CKD).

Research design and methods  In 40 initially non-dialysed diabetic patients with CKD (isotopic glomerular filtration rate < 60 ml/min/1.73 m2 or albumin excretion rate > 30 mg/24 h), body composition (DEXA scan) and glomerular filtration rate (GFR determined from 51Cr-EDTA clearance) were measured at a 2-year interval, and compared by paired t-tests.

Results  The 40 patients, mainly with Type 2 diabetes (n = 28), were men (n = 28), aged 65 ± 11 years, with diabetes duration 18 ± 11 years. GFR was initially 38.0 (range 8–89) ml/min/1.73 m2. CKD progressed during follow-up: eight started haemodialysis and GFR declined in the 32 others (P < 0.05 vs. initial). T-scores for total body (initial −0.61 ± 1.11, final −1.11 ± 1.40; P < 0.001) and femoral neck (initial −1.88 ± 0.15, final −2.07 ± 0.15; P < 0.05) declined. Ten patients were osteopaenic at baseline (no osteoporosis), whereas most were osteopaenic (n = 21, P < 0.05) and five were osteoporotic at final assessment. The 16 patients who became osteopaenic or osteoporotic during follow-up did not differ from the others for the type of diabetes, age, GFR, albumin excretion rate, HbA1c, GFR reduction and the requirement for dialysis during follow-up. They were all men (P < 0.01 by chi-squared test), with reduced initial total body T-score (−1.20 ± 0.82, others −0.32 ± 1.13; P < 0.05) and a lower body mass index (24.6 ± 4.3; others 27.7 ± 4.3; P < 0.05).

Conclusion  Bone loss, especially in the femoral neck, is progressive in diabetic patients with CKD.