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Differences in bone quality in low- and high-turnover renal osteodystrophy.

Hartmut H Malluche¹, Daniel S Porter, Marie-Claude Monier-Faugere

¹Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Albert B. Chandler Medical Center, Lexington, KY 40536-0298, USA. hhmall@uky.edu

Journal of the American Society of Nephrology : JASN

|December 24, 2011

Summary

Bone quality in chronic kidney disease (CKD) is affected differently by low or high bone turnover. Low turnover impairs microstructure, while high turnover damages material and nanomechanical properties, impacting bone strength.

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Area of Science:

Nephrology
Orthopedics
Biomaterials Science

Background:

Abnormal bone turnover is prevalent in chronic kidney disease (CKD).
The specific effects of low or high bone turnover on bone quality in CKD patients are not fully understood.
Bone quality is crucial for mechanical competence and fracture prevention.

Purpose of the Study:

To investigate the distinct impacts of low and high bone turnover on bone quality in patients with CKD.
To compare bone microstructural, material, and nanomechanical properties across different turnover states.
To elucidate the mechanisms by which altered bone turnover affects bone health in CKD.

Main Methods:

Qualitative screening of iliac crest bone specimens from CKD patients on dialysis (low/high turnover) and healthy controls.
Quantitative analysis using Fourier transform infrared spectroscopy and nanoindentation for material and mechanical properties.
Bone histomorphometry to assess microstructural parameters, bone formation, and resorption.

Main Results:

Low turnover bone exhibited microstructural deficits, including reduced cancellous bone volume and trabecular thickness.
High turnover bone displayed material and nanomechanical abnormalities, such as decreased mineral to matrix ratio and lower stiffness.
Both low and high turnover states in CKD lead to diminished bone quality, but through distinct pathological pathways.

Conclusions:

Turnover-related alterations in bone quality significantly contribute to the reduced mechanical competence of bone in CKD.
Low and high bone turnover in CKD affect bone quality via different mechanisms, impacting microstructure and material properties, respectively.
Developing targeted therapies for low- or high-turnover renal osteodystrophy may improve treatment efficacy.