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A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Bone turnover, osteopenia and vascular calcifications in hemodialysis patients. A histomorphometric and multislice CT
G Coen1, P Ballanti, D Mantella
1Ospedale Israelitico, Rome, Italy. giorgio.coen@gmail.com
Insights
Vascular calcifications in hemodialysis patients are not strongly linked to bone turnover or mass. Multivariate analysis suggests initial correlations were spurious, indicating these bone factors do not significantly predict calcification extent.
Area of Science:
- Nephrology
- Cardiology
- Bone Metabolism
Background:
- Vascular calcifications are common in hemodialysis patients, with classical risk factors identified.
- The role of bone turnover in vascular calcification requires further clarification.
- A potential link between primary osteoporosis and vascular calcifications has been proposed.
Purpose of the Study:
- To evaluate the relationship between bone turnover, bone histomorphometry, and vascular calcifications in hemodialysis patients.
- To investigate the association between primary osteoporosis and vascular calcifications.
Main Methods:
- A cohort of 32 hemodialysis patients underwent transiliac bone biopsy for histomorphometric and histodynamic evaluation.
- Multislice computerized tomography was used to quantify cardiac and coronary calcifications.
- Bone aluminum deposits were also assessed.
Main Results:
- Patients exhibited renal osteodystrophy with variable bone formation rates.
- Univariate analysis showed significant negative correlations between bone turnover rate and cardiac calcification score, and between calcification scores and trabecular number.
- Multivariate analysis excluded bone histomorphometric and histodynamic variables, identifying only age, hemodialysis duration, and serum calcium as predictors of calcification.
Conclusions:
- Multivariate analysis indicated a spurious association between vascular calcification scores and bone turnover/histomorphometric parameters.
- Bone turnover and trabecular mass do not appear to be significantly connected to the extent of cardiac and coronary calcifications in this patient group.
Background:
Several classical risk factors are at the base of vascular calcifications in hemodialysis patients. Among these, according to a general opinion, also bone turnover plays a role, which, however, requires a better definition. In addition, it has been suggested that there is a relationship between primary osteoporosis and vascular calcifications. This bone biopsy-based study on a hemodialysis patient cohort is a contribution to the evaluation of these alleged relations.
Methods:
This study has been carried out on a cohort of 32 patients on maintenance hemodialysis, who were subjected to transiliac bone biopsy for histomorphometric, histodynamic and bone aluminum deposit evaluation. The patients were also examined with multislice computerized tomography for quantitation of heart and coronary calcifications.
Results:
The patients were affected by renal osteodystrophy with a wide range of bone formation rate values. A significant negative correlation was found between the rate of bone turnover and log-transformed cardiac calcification score (p < 0.003). There were also negative significant correlations between the cardiac and coronary calcification score log and trabecular number (p < 0.02 and p < 0.05, respectively), while the correlations were positive with trabecular separation (p < 0.03 and p < 0.05, respectively). However, multiregression analysis, forward method, selected only age, hemodialysis age and serum Ca as predictive variables of cardiac and coronary calcification score log, while the histomorphometric and histodynamic variables were excluded.
Conclusions:
In this study, in spite of the suggestive findings of the univariate statistical approach, a further multivariate analysis was indicative of a spurious association between calcification scores and both bone turnover and histomorphometric parameters of trabecular mass and connectivity. Bone turnover and trabecular mass do not appear to be prominently connected with the extent of cardiac and coronary calcifications in hemodialysis patients.
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