Abstract: Objective To observe the changes of bone metabolism and bone mineral density (BMD) in the maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT). Methods Eighty-six MHD patients with SHPT were enrolled in this study and were assigned according to their serum intact parathyroid (iPTH) level into 4 groups, group A (150～300 pg/ml, n=23), group B (300～600 pg/ml, n=21), group C (600～1000 pg/ml, n=24) and group D (＞1000 pg/ml, n=18), and according to the presence or absence of diabetes into diabetes group and non-diabetes group. BMD and serum albumin, calcium, phosphorus, alkaline phosphatase (ALP) and iPTH were assayed. Changes of these parameters in different groups and their relevance to iPTH levels were analyzed. Results Serum phosphorus (LSD-t=2.030, P=0.049), L1-L4 BMD (LSD-t=4.591, P＜0.001) and young adult L1-L4 T value (LSD-t=4.813, P＜0.001) were significantly different between group B and group C. iPTH was significantly higher in non-diabetes group than in diabetes group (t=-7.387, P＜0.001), while left femur BMD (t=2.414, P =0.018), young adult left femur T value (t= 5.477, P＜0.001), left femoral Wards triangle BMD (t=3.252, P=0.020) and young adult left femoral Wards triangle T value (t=7.758, P＜0.001) were significantly lower in non-diabetes group than in diabetes group ( P＜ 0.05). In groups A, B, C and D, left femur BMD (1.07±0.18, 1.00±0.16, 0.84±0.15 and 0.78±0.43 respectively; F=5.616, P =0.001), young adult left femur T value (1.00±0.25, 0.12±1.24, -1.08 ±1.20 and -1.05±30 respectively; F=16.377, P =0.001), left femoral Wards triangle BMD (1.00±0.25, 0.91±0.25, 0.66±0.09 and 0.62±0.03 respectively; F=6.915, P＜0.001) and young adult left femoral Wards triangle T value (0.84±1.68, 0.18±1.62, -1.45±0.60 and -1.75±0.19 respectively; F=14.928, P＜0.001) decreased gradually along with the increase of serum iPTH level (P＜0.01). Correlation study revealed that iPTH level was positively correlated with ALP (r=0.782, P＜0.001), and negatively correlated with left femur BMD (r=-0.532, P=0.025), young adult left femur T value (r=- 0.520, P=0.004), left femoral Wards triangle BMD (r=- 0.514, P＜0.001), and young adult left femoral Wards triangle T value (r=-0.512, P＜0.001). Conclusions In MHD patients with SHPT, hyperphosphatemia may become a marker of lumbar bone metabolism abnormalities, and serum iPTH level can be used to estimate bone metabolism of femur, especially that of femoralWards triangle.

Key words: Maintenance hemodialysis, Hyperparathyroidism, Secondary, Bone mineral density