Bone turnover correlates with bone quantity but not bone microarchitecture in chronic hemodialysis

Area of Science:

• Nephrology
• Bone Metabolism
• Mineral and Bone Disorders

Background:

• Chronic hemodialysis is associated with high-turnover bone disease, characterized by reduced bone mineral density (BMD), compromised bone quality, and elevated fracture risk.
• Understanding the relationship between bone turnover markers (BTMs) and bone microarchitecture is crucial for managing bone disease in dialysis patients.

Purpose of the Study:

• To investigate the correlation between BTMs and bone microarchitecture, assessed by trabecular bone score (TBS).
• To examine these correlations before and after adjusting for BMD in patients undergoing chronic hemodialysis.

Main Methods:

• Dual X-ray absorptiometry was used to measure BMD at the lumbar spine, femoral neck, and 1/3 radius, along with LS TBS in 81 hemodialysis patients.
• Serum levels of parathyroid hormone, osteocalcin, C-terminal crosslaps of type 1 collagen, procollagen 1 N-terminal propeptide (P1NP), and alkaline phosphatase (ALP) were measured as BTMs.

Main Results:

• All BTMs showed significant intercorrelations.
• Univariate analysis revealed significant negative correlations between BTMs and both BMD and TBS.
• Multivariate regression indicated that TBS, whether crude or adjusted, correlated with LS BMD, but BTMs were not retained as independent predictors due to multicollinearity.

Conclusions:

• Bone microarchitecture progressively worsens with increasing bone turnover in chronic hemodialysis patients.
• This correlation is not significant when bone mass is accounted for, suggesting factors beyond high bone turnover contribute to impaired bone microarchitecture and fracture risk.