Bone Turnover–Guided Treatment of Low Bone Density in Haemodialysis ...

Link: https://onlinelibrary.wiley.com/doi/10.1111/nep.70151

Title: Bone Turnover–Guided Treatment of Low Bone Density in Haemodialysis Patients Using Bone Biopsy and Fluoride Positron Emission Tomography Imaging

Authors: Jeerath Phannajit, Kitiwat Khamwan, Viyada Sanoesan, Pobe Luangjarmekorn, Saran Tantavisut, Tanatorn Khotavivattana, Suthanit Laowalert, Lalita Wattanachanya, Kearkiat Praditpornsilpa, Kanaungnit Kingpetch, Paweena Susantitaphong

Abstract:

Aim: Chronic kidney disease–mineral and bone disorder (CKD–MBD) contributes to skeletal fragility through abnormalities in bone turnover. This study evaluated turnover-guided therapy using bone histomorphometry and 18F-NaF PET/CT in haemodialysis patients with low bone mineral density (BMD).

Methods: Adult haemodialysis patients at a single centre (2018–2024) underwent turnover assessment by bone biopsy (n = 31) or PET/CT (n = 27). Patients were grouped according to whether treatment followed an institutional turnover-guided protocol introduced in 2020. Outcomes included changes in BMD, bone turnover markers (BTMs), and PET-derived Ki values. For the biopsy cohort, multiple linear regression assessed treatment effects.

Results: In the biopsy cohort, protocol-consistent treatment preserved distal radius BMD compared with historical controls. The annualised difference was +2.06% (95% CI 0.74–3.38; p = 0.005) unadjusted and +2.38% (95% CI 0.24–4.51; p = 0.033) adjusted. No significant effects were seen at spine, hip, or femoral neck. BTMs decreased in protocol-treated patients (B-ALP –32.2%, TRACP5b −48.1%), while controls showed no significant change. In the PET/CT cohort, high-turnover patients (n = 13) showed reductions in Ki at the iliac crest (−17.1%) and lumbar spine (−14.4%), alongside decreases in BTMs (B-ALP –22.6%, TRACP5b −40.0%). Distal radius BMD improved at 1 year in patients whose turnover normalised (+2.1% vs. −2.4%; p = 0.04).

Conclusion: Turnover-guided treatment was associated with improvements in BMD, BTMs, and PET-derived metabolic activity. These findings suggest the potential utility of turnover-informed therapy in CKD–MBD and support ¹⁸F-NaF PET/CT as a non-invasive alternative to biopsy.

Cite this:

Phannajit, J.; Khamwan, K.; Sanoesan, V.; Luangjarmekorn, P.; Tantavisut, S.; Khotavivattana, T.; Laowalert, S.; Wattanachanya, L.; Praditpornsilpa, K.; Kingpetch, K.; Susantitaphong, P. "Bone Turnover–Guided Treatment of Low Bone Density in Haemodialysis Patients Using Bone Biopsy and Fluoride Positron Emission Tomography Imaging" Nephrology 2025, 30, e70151. https://doi.org/10.1111/nep.70151