Bone turnover markers predict type of bone histomorphometry and bone mineral density in Asian chronic hemodialysis patients

Link: https://onlinelibrary.wiley.com/doi/10.1111/nep.13593 

Title: Bone turnover markers predict type of bone histomorphometry and bone mineral density in Asian chronic hemodialysis patients

Authors: Suthanit Laowalert, Tanatorn Khotavivattana, Lalita Wattanachanya, Pobe Luangjarmekorn, Suwasin Udomkarnjananun, Pisut Katavetin, Somchai Eiam‐Ong, Kearkiat Praditpornsilpa, Paweena Susantitaphong*

Abstract:  

Background: Although the levels of intact parathyroid hormone (iPTH) are well‐controlled following the KDIGO guideline, the incidence of osteoporosis and fracture are still high in hemodialysis (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‐labeled iliac crest bone specimens were evaluated using specialized 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. Conclusions: Although iPTH levels were close to the target of KDIGO 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.

Cite this: 

Laowalert, S.; Khotavivattana, T.; Wattanachanya, L.; Luangjarmekorn, P.; Udomkarnjananun, S.; Katavetin, P.; Eiam‐Ong, S.; Praditpornsilpa, K.; Susantitaphong, P. Bone turnover markers predict type of bone histomorphometry and bone mineral density in Asian chronic hemodialysis patients. Nephrology 2020, 25, 163-171.