The aim of this study was to investigate the bone status of hemodialysis patients and identify factors that have influence on bone quality. Four hundred eighty-nine subjects (213 males and 276 females) on maintenance hemodialysis and 696 healthy subjects (309 men, 387 women) were enrolled in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) were assessed by quantitative ultrasound (QUS) at the right calcaneus in both groups. Serum levels of intact parathyroid hormone (iPTH), total alkaline phosphatase (ALP), calcium and phosphate were measured to determine their influence on bone status in hemodialysis patients. All QUS parameters were significantly lower in hemodialysis patients than in controls (p<0.0001). Stepwise multiple linear regression analysis in male patients indicated that age, weight, calcium-phosphate product and ALP were significant predictors of QUS parameters (adjusted R2 = 0.15 in SOS; adjusted R2 = 0.17 in BUA and QUI). In female patients, same findings including number of parity were observed in SOS only (adjusted R2 = 0.25 in SOS). In postmenopausal patients, the duration of menopause was significant negatively correlated with all QUS parameters (p< 0.01). In conclusion, patients on maintenance hemodialysis had additional risk of bone loss. Advanced age, low body weight, high calcium-phosphate product and high ALP level were important risk factors for deterioration of bone quality. Early assessment of the bone status in hemodialysis patients is essential to prevent osteoporosis.

本研究主要評估血液透析病患的骨質狀態，並分析影響骨質的因子。489位(213位男性；276位女性)血液透析病患與696位(309男性；387位女性)正常受檢者，均接受定量式超音波儀(quantitative ultrasound, QUS)測量右腳跟骨之骨質檢測，測量QUS的參數包括音波速度(speed of sound, SOS)、寬頻衰減值(broadband ultrasound attenuation, BUA)與定量式超音波指數(quantitative ultrasound index, QUI)。為評估影響骨質的因子，血液透析病患進一步測量血液生化值，包括副甲狀腺素(intact parathyroid hormone, iPTH)、鹼性磷酸酶(alkaline phosphatase, ALP)、血鈣值和血磷值等。研究結果顯示：血液透析病患的超音波參數均較正常受檢者為低，且有統計上的差異(p>0.0001)。為評估影響骨質的危險因子，於逐步多元回歸分析中，男性病患顯示年齡、體重、生化數值中的鈣磷乘積和ALP皆為影響QUS參數的因子(SOS的調整R2 =0.15；BUA和QUI的調整R2 =0.17)。同樣的影響因子與生產胎數僅發現於女性病患中的SOS參數(調整R2 =0.25)。此外，對於停經後的女性病患，停經期間與QUS參數成負相關(p<0.01)。此研究發現血液透析病患有明顯的骨質流失，年齡增長、體重過低、高鈣磷乘積與高ALP皆為影響骨質惡化的主要因素，因此建議早期監測血液透析病患的骨質狀況，以避免產生骨質疏鬆症。

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