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Bone turnover markers predict type of bone histomorphometry and bone mineral density in Asian chronic haemodialysis
Suthanit Laowalert1, Tanatorn Khotavivattana2, Lalita Wattanachanya3
1Division of Nephrology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Insights
Despite controlled intact parathyroid hormone (iPTH) levels in hemodialysis patients, abnormal bone conditions persist. Bone biopsy remains essential for accurate diagnosis and treatment guidance in managing renal osteodystrophy.
Area of Science:
- Nephrology
- Bone Metabolism
- Mineral and Bone Disorders
Background:
- Hemodialysis (HD) patients often experience high rates of osteoporosis and fractures, even with controlled intact parathyroid hormone (iPTH) levels.
- The Kidney Disease Outcomes Quality Initiative guideline aims to manage iPTH, but its effectiveness in preventing bone complications requires further investigation.
Purpose of the Study:
- To investigate the correlation between bone turnover markers, bone mineral density (BMD), and bone histomorphometry in chronic HD patients.
- To assess the diagnostic accuracy of serum iPTH and TRAP-5b in predicting high bone turnover.
Main Methods:
- Twenty-two chronic HD patients were enrolled, with measurements of serum bone turnover markers.
- Iliac crest bone specimens underwent double tetracycline labeling and evaluation using Osteomeasure software for histomorphometry.
- Bone mineral density (BMD) and coronary artery calcification were also determined.
Main Results:
- Bone histomorphometry revealed high prevalence of osteitis fibrosa (50%) and adynamic bone disease (45%).
- Serum iPTH and TRAP-5b showed significant predictive value for high bone turnover (ROC 0.833 and 0.733, respectively).
- Low BMD and severe vascular calcification were common, but no significant correlations were found between bone biomarkers and BMD or vascular calcification.
Conclusions:
- Abnormal bone histomorphometry, low BMD, and severe vascular calcification remain prevalent in HD patients despite iPTH levels near guideline targets.
- Serum iPTH and TRAP-5b can indicate high bone turnover, but bone biopsy is crucial for accurate diagnosis.
- Bone biopsy remains the gold standard for guiding optimal treatment strategies in HD-related bone disease.
Background:
Although the levels of intact parathyroid hormone (iPTH) are well-controlled following the Kidney Disease Outcomes Quality Initiative guideline, the incidence of osteoporosis and fracture are still high in haemodialysis (HD) patients. This study was conducted to investigate the correlation between bone turnover markers, bone mineral density (BMD), and bone histomorphometry in HD patients.
Methods:
Twenty-two chronic HD patients were enrolled. Serum levels of bone turnover markers were measured. Double tetracycline-labelled iliac crest bone specimens were evaluated using specialized a computer program (Osteomeasure). The types of bone histomorphometry were classified based on turnover, mineralization and volume. BMD and coronary artery calcification were also determined.
Results:
Bone histomorphometry revealed osteitis fibrosa (50%), adynamic bone disease (45%) and mixed uremic osteodystrophy (5%). Serum iPTH level predicted high bone turnover with area under the receiver operating characteristic (ROC) of 0.833 (95% CI = 0.665-1.000, P = 0.008). Serum TRAP-5b also had ROC of 0.733 (95% CI = 0.517-0.950, P = 0.065). In addition, when using serum iPTH (cut-off 484.50 ng/mL) or serum TRAP-5b (cut-off 1.91 pg./mL) to predict high turnover, the sensitivity was 0.917. On the other hand, when both iPTH and TRAP-5B were above these cut-off, the specificity was 1.000. Low BMD and severe vascular calcification were commonly identified. However, there were no significant correlations between bone biomarkers and BMD or severe vascular calcification.
Conclusion:
Although iPTH levels were close to the target of Kidney Disease Outcomes Quality Initiative guideline, abnormal bone histomorphometry, BMD, and severe vascular calcification are still common. Bone biopsy is still crucially required as an accurate diagnostic tool in providing optimal guide for the treatment. © 2019 Asian Pacific Society of Nephrology.
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