Adynamic bone disease: clinical and therapeutic implications

Frazão, João; Martins, Patrícia

doi:10.1097/mnh.0b013e32832c4df0

Cited by 43 publications

(46 citation statements)

References 37 publications

(40 reference statements)

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“…Three important patient-level factors seem most strongly to underpin low bone formation: aging of the patient population, the presence of diabetes, and the use of increased calcium loading in the context of oral phosphate binding. All of these factors have increased between 1990 and 2010, explaining the current major predominance of adynamic bone disease in biopsy series (14).…”

Section: A Brief History Of Pth Measurementsmentioning

confidence: 99%

PTH—A Particularly Tricky Hormone

Garrett

Sardiwal

Lamb

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryPlasma parathyroid hormone (PTH) concentrations are commonly measured in the context of CKD, as PTH concentration elevation is typical in this clinical context. Much has been inferred from this raised PTH concentration tendency, both about the state of skeletal integrity and health and also about the potential clinical outcomes for patients. However, we feel that reliance on PTH concentrations alone is a dangerous substitute for the search for, and use of, more precise and reliable biomarkers. In this article, we rehearse these arguments, bringing together patient-level and analytical considerations for the first time.

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Section: A Brief History Of Pth Measurementsmentioning

confidence: 99%

PTH—A Particularly Tricky Hormone

Garrett

Sardiwal

Lamb

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…In this study, PTX was considered necessary when, despite optimal medical and dietary treatment, high serum iPTH persisted in combination with hypercalcemia, vascular calcification, severe osteopathy, drug-resistant hyperphosphatemia, and calciphylaxis. In addition, the diagnostic process was required to exclude adynamic bone disease (Frazao and Martins 2009). All 30 patients underwent PTX in the nephrology unit of either the Cardinal Tien Hospital or the Tri-Service General Hospital, both situated in Taipei, Taiwan.…”

Section: Patientsmentioning

confidence: 99%

Association between Increased Serum Osteoprotegerin Levels and Improvement in Bone Mineral Density after Parathyroidectomy in Hemodialysis Patients

Zheng

Chu

et al. 2012

Tohoku J. Exp. Med.

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Secondary hyperparathyroidism (SHPT) is a common complication in chronic renal disease. Osteoprotegerin (OPG), an extracellular cytokine receptor secreted by osteoblasts, can promote bone formation by inhibiting the function of osteoclasts. Hemodialysis (HD) patients have elevated serum OPG levels. OPG secretion can be suppressed with high parathyroid hormone (PTH) levels. HD patients with refractory SHPT can benefit from parathyroidectomy (PTX) treatment, but the changes of serum OPG, bone turnover markers and bone mineral density (BMD) following PTX in HD patients remain unclear. In this study, patients on maintenance HD who received PTX for refractory SHPT (n = 28) were prospectively followed for 1 year. Serum intact PTH (iPTH), alkaline phosphatase (Alk-P), and OPG were measured serially; BMD was measured pre-PTX and at 1 year after PTX. After PTX, serum iPTH levels reduced profoundly. Serum Alk-P levels increased rapidly, peaking at 2 weeks post-PTX, while serum OPG levels gradually increased at 2 weeks after PTX and peaked at 2 months. BMD improved in both femoral neck (FN; cancellous and cortical bone) and lumbar spine (LS; cancellous bone). Higher baseline iPTH levels were associated with greater FN and LS BMD improvements at one year after PTX. The increment of serum OPG was correlated with the increase in LS BMD, implying that inhibition of osteoclastic bone resorption may improve BMD within the first year after PTX. These findings suggest that PTX removes the suppressive effects of high PTH on OPG secretion, resulting in the increased serum OPG levels that may contribute to BMD improvement.

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“…A diagnosis of adynamic bone disease was excluded based on iPTH and bone-specific alkaline phosphatase levels. A diagnosis of adynamic bone disease in HD patients was made when the plasma iPTH concentration was <100-150 pg/ml and the bone-specific alkaline phosphatase concentration was <27 U/l [19]. We excluded from the study those patients with a plasma iPTH concentration <200 pg/ml and bone-specific alkaline phosphatase concentration <27 U/l.…”

Section: Methodsmentioning

confidence: 99%

Effects of Pamidronate and Calcitriol on the Set Point of the Parathyroid Gland in Postmenopausal Hemodialysis Patients with Secondary Hyperparathyroidism

Huang

Zheng

et al. 2013

Nephron Clin Pract

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Background/Aims: Secondary hyperparathyroidism may worsen after the administration of pamidronate in postmenopausal hemodialysis (HD) patients. The aim of this study was to evaluate the short-term effect of coadministration of calcitriol and pamidronate on dynamic parathyroid hormone (PTH) secretion. Methods: Fifteen postmenopausal women undergoing regular HD with serum intact PTH levels of >200 pg/ml were enrolled. The PTH-ionized calcium (iCa) curve was evaluated by the response to hypo- and hypercalcemia induced with 1 and 4 mEq/l of dialysate calcium, respectively. Parameters were compared after pamidronate was administered and after coadministration of pamidronate and calcitriol. Changes in serum levels of maximal serum PTH (PTH_max), basal PTH (PTH_base) and minimal PTH (PTH_min) were evaluated. Results: Pamidronate therapy resulted in a decrease in predialysis basal plasma iCa (p < 0.05) and an increase in PTH_max (p < 0.01), PTH_base (p < 0.01) and PTH_min (p < 0.01). The change in serum iCa and PTH was reversed after the coadministration of calcitriol and pamidronate. Conclusion: Our study demonstrated that pamidronate therapy is associated with a reduced plasma iCa and increased PTH secretion. These adverse effects may be reversed by calcitriol. These findings suggest that in considering pamidronate treatment in postmenopausal patients with osteoporosis receiving HD, it might be safer to add calcitriol to prevent the increased PTH secretion.

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Adynamic bone disease: clinical and therapeutic implications

Cited by 43 publications

References 37 publications

PTH—A Particularly Tricky Hormone

PTH—A Particularly Tricky Hormone

Association between Increased Serum Osteoprotegerin Levels and Improvement in Bone Mineral Density after Parathyroidectomy in Hemodialysis Patients

Effects of Pamidronate and Calcitriol on the Set Point of the Parathyroid Gland in Postmenopausal Hemodialysis Patients with Secondary Hyperparathyroidism

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