H H Malluche1, M-C Monier-Faugere2, G Blomquist3, D L Davenport4. 1. Division of Nephrology Bone and Mineral Metabolism, University of Kentucky, 800 Rose Street, Room MN 564, Lexington, KY, 40503, USA. hhmall@uky.edu. 2. Division of Nephrology Bone and Mineral Metabolism, University of Kentucky, 800 Rose Street, Room MN 564, Lexington, KY, 40503, USA. 3. Department of Radiology, University of Kentucky, Lexington, KY, USA. 4. Department of Surgery, University of Kentucky, Lexington, KY, USA.
Abstract
This prospective two-year study of patients on chronic dialysis measured changes in bone mineral density (BMD). Patients with higher baseline BMD and shorter dialysis vintage lost more bone. Treatment with anti-hypertensives acting on the central nervous system was protective against bone loss. Baseline serum levels of sclerostin and bone-specific alkaline phosphatase predicted bone loss. INTRODUCTION: This prospective 2-year study of chronic kidney disease on dialysis (CKD-5D) patients assessed trabecular and cortical bone loss at the hip and spine and examined potential demographic, clinical, and serum biochemical predictors of bone loss. METHODS: Eighty-nine CKD-5D patients had baseline, year 1, and year 2 bone mineral density (BMD) measurements using dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT); concurrent blood samples were drawn and clinical variables recorded. No study treatments occurred. RESULTS: The 2-year total hip BMD change was - 5.9% by QCT and - 3.1% by DXA (p < 0.001). Spinal BMD was unchanged. QCT total hip cortical mass and volume decreased (- 7.3 and - 10.0%); trabecular volume increased by 5.9% (ps < 0.001). BMD changes did not vary with age, BMI, race, diabetes, smoking, or exercise. Patients with higher baseline BMD and shorter dialysis vintage lost more bone (p < 0.05). Vitamin D analogs and phosphate binders were not protective against bone loss; cinacalcet was protective by univariate but not by multivariable analysis. CNS-affecting antihypertensives were protective against loss of BMD, cortical mass, cortical volume (ps < 0.05) and trabecular mass (p = 0.007). These effects remained after adjustment. BSAP correlated with changes in BMD, cortical mass, and volume (p < 0.01) as did sclerostin (inversely). CONCLUSIONS: There was severe cortical bone loss at the hip best recognized by QCT. Patients with shorter dialysis vintage and less pre-existing bone loss lost more bone, while treatment with CNS-acting antihypertensives was protective. BSAP and sclerostin were useful markers of bone loss.
This prospective two-year study of patients on chronic dialysis measured changes in bone mineral density (BMD). Patients with higher baseline BMD and shorter dialysis vintage lost more bone. Treatment with anti-hypertensives acting on the central nervous system was protective against bone loss. Baseline serum levels of sclerostin and bone-specific alkaline phosphatase predicted bone loss. INTRODUCTION: This prospective 2-year study of chronic kidney disease on dialysis (CKD-5D) patients assessed trabecular and cortical bone loss at the hip and spine and examined potential demographic, clinical, and serum biochemical predictors of bone loss. METHODS: Eighty-nine CKD-5D patients had baseline, year 1, and year 2 bone mineral density (BMD) measurements using dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT); concurrent blood samples were drawn and clinical variables recorded. No study treatments occurred. RESULTS: The 2-year total hip BMD change was - 5.9% by QCT and - 3.1% by DXA (p < 0.001). Spinal BMD was unchanged. QCT total hip cortical mass and volume decreased (- 7.3 and - 10.0%); trabecular volume increased by 5.9% (ps < 0.001). BMD changes did not vary with age, BMI, race, diabetes, smoking, or exercise. Patients with higher baseline BMD and shorter dialysis vintage lost more bone (p < 0.05). Vitamin D analogs and phosphate binders were not protective against bone loss; cinacalcet was protective by univariate but not by multivariable analysis. CNS-affecting antihypertensives were protective against loss of BMD, cortical mass, cortical volume (ps < 0.05) and trabecular mass (p = 0.007). These effects remained after adjustment. BSAP correlated with changes in BMD, cortical mass, and volume (p < 0.01) as did sclerostin (inversely). CONCLUSIONS: There was severe cortical bone loss at the hip best recognized by QCT. Patients with shorter dialysis vintage and less pre-existing bone loss lost more bone, while treatment with CNS-acting antihypertensives was protective. BSAP and sclerostin were useful markers of bone loss.
Entities:
Keywords:
Bone markers; DXA; Dialysis; Osteoporosis; QCT; Renal osteodystrophy
Authors: Frederic Morvan; Kim Boulukos; Philippe Clément-Lacroix; Sergio Roman Roman; Isabelle Suc-Royer; Béatrice Vayssière; Patrick Ammann; Patrick Martin; Sonia Pinho; Philippe Pognonec; Patrick Mollat; Christof Niehrs; Roland Baron; Georges Rawadi Journal: J Bone Miner Res Date: 2006-06 Impact factor: 6.741
Authors: Catarina Carvalho; J Magalhães; R Neto; L Pereira; P Branco; T Adragão; J M Frazão Journal: J Bone Miner Metab Date: 2016-11-09 Impact factor: 2.626
Authors: A L Negri; E E Del Valle; M B Zanchetta; M Nobaru; F Silveira; M Puddu; R Barone; C E Bogado; J R Zanchetta Journal: Osteoporos Int Date: 2012-01-11 Impact factor: 4.507
Authors: Joseph J Pinzone; Brett M Hall; Nanda K Thudi; Martin Vonau; Ya-Wei Qiang; Thomas J Rosol; John D Shaughnessy Journal: Blood Date: 2008-08-07 Impact factor: 22.113
Authors: Francesca Tentori; Keith McCullough; Ryan D Kilpatrick; Brian D Bradbury; Bruce M Robinson; Peter G Kerr; Ronald L Pisoni Journal: Kidney Int Date: 2013-07-31 Impact factor: 10.612
Authors: Ludmila Brunerová; Petr Kasalický; Jana Verešová; Renata Lažanská; Jana Potočková; Ivan Rychlík Journal: Int Urol Nephrol Date: 2020-02-03 Impact factor: 2.370
Authors: P Evenepoel; J Cunningham; S Ferrari; M Haarhaus; M K Javaid; M-H Lafage-Proust; D Prieto-Alhambra; P U Torres; J Cannata-Andia Journal: Osteoporos Int Date: 2021-06-15 Impact factor: 4.507
Authors: Satu Keronen; Leena Martola; Patrik Finne; Inari S Burton; Xiaoyu F Tong; Heikki Kröger; Eero Honkanen Journal: PLoS One Date: 2022-03-29 Impact factor: 3.240
Authors: Daniela F Cardoso; Elisa A Marques; Diogo V Leal; Aníbal Ferreira; Luke A Baker; Alice C Smith; João L Viana Journal: BMC Nephrol Date: 2020-08-08 Impact factor: 2.388