A case of ischemic osteopathy in a hemodialysis patient with advanced peripheral artery disease.

Peripheral artery disease (PAD) or arteriosclerosis obliterans is a lethal complication highly prevalent in pre-dialysis CKD and dialyzed patients. PAD is driven by atherosclerotic process and causes ischemia of the affected limb. Given that normal bone metabolism is based on sufficient blood supply and PAD decreases intraosseous blood flow of the affected limb, it is probable that PAD can directly cause ischemic osteopathy or osteoporosis in affected limbs. We herein present a 69-year-old female patient receiving 18 years of maintenance hemodialysis therapy was hospitalized for the treatment of bilateral PAD. Angiography showed a diffuse stenosis of the right superficial femoral artery and total occlusion of the left superficial femoral artery. Right ankle brachial index (ABI) was 0.83, whereas left ABI was unmeasurable. Notably, T score of the bone mineral density (BMD) in the right calcaneus measured by quantitative ultrasound was - 1.4, while that in the left calcaneus was - 2.2, showing a huge difference between BMD in the bilateral calcaneus. Metal stent was inserted to the right superficial femoral artery, whereas femoropopliteal bypass surgery was performed for the left limb. After the surgery, her right and left ABI were 0.96 and 0.92, respectively. Our case typically showed the clinical significance of sufficient blood supply to the bone for the normal bone metabolism and reminds us of the potential need to conduct further research on the association between PAD and ischemic osteopathy in patients with CKD.