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Current issues in the management of secondary hyperparathyroidism and bone disease
1Wishard Memorial Hospital, Indiana University School of Medicine, Indianapolis 46202, USA. smoe@iupui.edu
Insights
Maintaining bone mass may reduce vascular calcification, especially in dialysis patients. New medications help achieve target phosphorus, calcium x phosphorus product, and parathyroid hormone levels.
Area of Science:
- Vascular biology
- Bone metabolism
- Nephrology
Background:
- Vascular tissue exhibits bone-like remodeling in dialysis and non-dialysis patients.
- Vascular calcification is inversely related to bone mass.
Purpose of the Study:
- To explore the link between bone mass and vascular calcification.
- To highlight the importance of managing mineral and bone metabolism in patients.
Main Methods:
- Cross-sectional study analysis.
- Review of current research on vascular calcification and bone metabolism.
Main Results:
- Normal bone turnover and mass may decrease vascular calcification.
- Target serum phosphorus levels: 3.5-5.5 mg/dL.
- Target Ca x P product: <55 mg/dL.
- Target intact parathyroid hormone (PTH): 150-200 pg/mL.
Conclusions:
- Achieving optimal mineral and bone metabolism targets is now more feasible.
- New pharmacologic agents are crucial for managing these targets effectively.
Abstract:
Recent research has demonstrated active bone-like remodelling of vascular tissue in dialysis and non dialysis patients. Cross-sectional studies indicate that the presence of vascular calcification is inversely related to bone mass. Theoretically, the relationship implies that maintaining normal bone turnover and mass may help to decrease vascular calcification. In addition, it is now apparent that phosphorus and the Ca x P product need to be kept as close to normal as possible. Thus, the present goal should be a serum phosphorus of 3.5-5.5 mg/dL, a Ca x P product of <55 mg/dL, and a PTH of around 150-200 pg/mL with the intact assay. Ten years ago, those goals would have been impossible. However, new pharmacologic agents will make their achievement much more realistic.