The effects of extreme low frequency pulsed electromagnetic field on bone mineral density and incidence of fractures in patients with end -- stage renal disease on dialysis -- three year follow up study.

Efekti pulsnog elektromagnetnog polja ekstremno niske frekvencije na gustinu kosti i incidenciju preloma kod bolesnika sa terminalnom bubrežnom slabošću na dijalizi: trogodišnja studija praćenja.

ELECTROMAGNETIC fields; CHRONIC kidney failure; BONE density; HEMODIALYSIS; BONE fractures; RANDOMIZED controlled trials

Background/Aim. A variety of physical therapy options has been developed for the treatment of musculoskeletal disorders including those characterized with low bone mineral density (BMD). Extreme low frequency pulsed electromagnetic field (ELF-PEMF) can accelerate bone formation. Patients with end stage of renal disease (ESRD) are predisposed to high incidence of fractures due to bone disorder with multifactorial pathogenesis. Vitamin D, calcium supplements, antiresorptive and anabolic drugs in those patients have changed pharmacodynamics and pharmacokinetics and have minimal or limited effects. The aim of this study was to assess the effectiveness of longterm ELF-PEMF therapy applied in concordance with physical exercise on bone mass, incidence of new bone fractures and parathyroid hormone concentrations in ESRD patients on dialysis. Methods. In this 3-year prospective clinical trial, 151 patients with ESRD on dialysis program were subjected to treatment with ELF-PEMF (18 Hz, 2 mT) applied during 40 min after 10 consecutive dialysis procedures, 4 times through one year (120 treatments in total during three years) together with kinesitherapy (study group) or only with kinesitherapy (control group) on the voluntary basis. Results. Total of 124 patients have completed the study. In the study group (n = 54), regardless of sex, significant improvements of BMD, T-score and Z-score on both lumbar spine and femoral neck were achieved after 3-year treatment with ELF-PEMF. In the control group (n = 70), significant decreases of BMD, T-score and Z-score as well as the higher incidence of new bone fractures were recorded. Conclusion. ELF-PEMF could be a convenient and safe non-pharmacological therapeutic strategy for fracture prevention in nephrology practices. [ABSTRACT FROM AUTHOR]

Uvod/Cilj. Različite metode fizikalne terapije koriste se u lečenju mišićno-skeletnih oboljenja uključujući i ona koja se karakterišu sniženom mineralnom koštanom gustinom (BMD). Pulsno elektromagnetno polje ekstremno niske frekvencije (ELF-PEMF) stimuliše formiranje koštanog tkiva. Zbog poremećaja koštanog tkiva multifaktorijalne patogeneze bolesnici sa terminalnom bubrežnom slabošću (TBS) imaju visoku učestalost preloma. Vitamin D, suplementi kalcijuma, antiresorptivni i anabolički lekovi kod ovih bolesnika, zbog izmenjene farmakodinamike i farmakokinetike imaju minimalne ili ograničene efekte. Cilj ovog rada bio je da se ispitaju efekti dugotrajne primene ELF-PEMF u kombinaciji sa kineziterapijom na BMD, učestalost novih preloma kostiju i koncentraciju parathormona kod bolesnika sa TBS na programu hemodijalize. Metode. U 3-godišnjoj prospektivnoj kliničkoj studiji bolesnici, njih 151, sa TBS na programu hemodijalize na dobrovoljnoj bazi, svrstani su u dve grupe: studijska grupa (ELF-PEMF, 18 Hz, 2 mT, pri-menjivana tokom 40 min posle 10 uzastopnih procedura hemodijalize, četiri puta tokom jedne godine, ukupno 120 tretmana tokom tri godine uz kineziterapiju) i kontrolna grupa (samo kineziterapija). Rezultati. Ukupno 124 bolesnika je završilo ispitivanje. U studijskoj grupi (n = 54), nezavisno od pola, posle tri godine primene ELF-PEMF postignuto je značajno poboljšanje BMD, T-skora i Z-skora na lumbalnoj kičmi i vratu butne kosti. U kontrolnoj grupi (n = 70), primećeno je značajno smanjenje BMD, T-skora i Z-skora uz veću incidencu novih preloma kostiju. Zaključak. Tehnika ELF-PEMF mogla bi predstavljati korisnu i bezbednu nefarmakološku metodu u programu prevencije preloma kod bolesnika sa TBS. [ABSTRACT FROM AUTHOR]

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