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Published on: June 2, 2022
Association between bone mineral metabolism and vascular calcification in end-stage renal disease
Louise Aaltonen1, Niina Koivuviita2, Marko Seppänen3,4
1Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland. louise.aaltonen@tyks.fi.
Insights
Vascular calcification is common in dialysis patients with cardiovascular disease. This study found a weak link between bone turnover and arterial calcification, suggesting other factors diminish bone remodeling's impact.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Bone Metabolism
Background:
- Vascular calcification is accelerated in end-stage renal disease patients.
- Abnormal bone and mineral metabolism contribute to cardiovascular disease (CVD) burden in dialysis patients.
- Aortic and coronary calcification scores predict CVD and mortality.
Purpose of the Study:
- To evaluate the relationship between arterial calcification and bone metabolism in dialysis patients.
Main Methods:
- 32 dialysis patients underwent bone biopsy for histomorphometry and 18F-NaF PET scans.
- Fluoride activity measured in lumbar spine and iliac crest.
- Arterial calcification assessed by CT (coronary) and radiography (aortic).
Main Results:
- High prevalence of arterial calcification (59% had CVD).
- Coronary artery calcification (CAC) and aortic artery calcification (AAC) were higher in patients with CVD.
- Weak associations found between bone turnover markers (fluoride activity, PTH, erosion surfaces) and calcification scores.
Conclusions:
- The link between bone remodeling and vascular calcification is complex in dialysis patients with comorbidities.
- While an association exists, bone remodeling's impact may be diminished by other calcification factors.
- Further research is needed to understand the interplay of factors in vascular calcification development.
Background:
Development of vascular calcification is accelerated in patients with end-stage renal disease. In addition to traditional risk factors of cardiovascular disease (CVD) abnormal bone and mineral metabolism together with many other factors contribute to the excess cardiovascular burden in patients on dialysis. Aortic calcification score and coronary calcification score are predictive of CVD and mortality. The aim of this study was to evaluate the possible relationship between arterial calcification and bone metabolism.
Methods:
Thirty two patients on dialysis were included. All patients underwent a bone biopsy to assess bone histomorphometry and a 18F-NaF PET scan. Fluoride activity was measured in the lumbar spine (L1 - L4) and at the anterior iliac crest. Arterial calcification scores were assessed by computerized tomography for quantification of coronary artery calcification score and lateral lumbar radiography for aortic calcification score.
Results:
This study group showed high prevalence of arterial calcification and 59% had verified CVD. Both CAC and AAC were significantly higher in patients with verified CVD. Only 22% had low turnover bone disease. There was a weak association between fluoride activity, which reflects bone turnover, measured in the lumbar spine, and CAC and between PTH and CAC. There was also a weak association between erosion surfaces and AAC. No significant association was found between calcification score and any other parameter measured.
Conclusions:
The results in this study highlight the complexity, when evaluating the link between bone remodeling and vascular calcification in patients with multiple comorbidities and extensive atherosclerosis. Several studies suggest an impact of bone turnover on development of arterial calcification and there is some evidence of reduced progression of vascular calcification with improvement in bone status. The present study indicates an association between vascular calcification and bone turnover, even though many parameters of bone turnover failed to show significance. In the presence of multiple other factors contributing to the development of calcification, the impact of bone remodeling might be diminished.
Trial Registration:
The study is registered in ClinicalTrials.gov protocol registration and result system, ID is NCT02967042 . Date of registration is 17/11/2016.
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