Bone Density and Cortical Structure after Pediatric Renal Transplantation

Terpstra, Anniek M.; Kalkwarf, Heidi J.; Shults, Justine; Zemel, Babette S.; Wetzsteon, Rachel J.; Foster, Bethany J.; Strife, C. Frederic; Foerster, Debbie; Leonard, Mary B.

doi:10.1681/asn.2011050480

Cited by 36 publications

(59 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2, 10 Reference participants were excluded for medical history of illness or medications that could affect growth and development. A total of 269 completed a 12 month visit in a longitudinal substudy.…”

Section: Methodsmentioning

confidence: 99%

Changes in bone structure and the muscle–bone unit in children with chronic kidney disease

Tsampalieros

Kalkwarf

Wetzsteon

et al. 2013

Kidney International

Self Cite

View full text Add to dashboard Cite

The impact of pediatric chronic kidney disease (CKD) on acquisition of volumetric bone mineral density (BMD) and cortical dimensions is lacking. To address this issue we obtained tibia quantitative computed tomography scans from 103 patients age 5-21 years with CKD (26 on dialysis) at baseline and 12 months later. Gender, ethnicity, tibia length and/or age-specific Z-scores were generated for trabecular and cortical BMD, cortical area, periosteal and endosteal circumference, and muscle area based on over 700 reference subjects. Muscle area, cortical area, and periosteal and endosteal Z-scores were significantly lower at baseline compared to the reference cohort. Cortical BMD, cortical area and periosteal Z-scores all exhibited a significant further decrease over 12 months. Higher parathyroid hormone levels were associated with significantly greater increases in trabecular BMD and decreases in cortical BMD in younger patients (significant interaction terms for trabecular BMD and cortical BMD). The estimated GFR was not associated with changes in BMD Z-scores independent of parathyroid hormone. Changes in muscle and cortical area were significantly and positively associated in control subjects but not in CKD patients. Thus, children and adolescents with CKD have progressive cortical bone deficits related to secondary hyperparathyroidism and potential impairment of the functional muscle-bone unit. Interventions are needed to enhance bone accrual in childhood-onset CKD.

show abstract

Section: Methodsmentioning

confidence: 99%

Changes in bone structure and the muscle–bone unit in children with chronic kidney disease

Tsampalieros

Kalkwarf

Wetzsteon

et al. 2013

Kidney International

Self Cite

View full text Add to dashboard Cite

show abstract

“…18, 20, 29 Z-scores were created for BSAP and DPD relative to sex and Tanner stage of maturation, as previously described. 30 Given the strong association between bone biomarker Z-scores and growth, the associations between PTH levels and bone biomarker Z-scores at baseline were assessed adjusted for height Z-score. 31 …”

Section: Methodsmentioning

confidence: 99%

Changes in Vitamin D and Parathyroid Hormone Metabolism in Incident Pediatric Crohnʼs Disease

Prosnitz

Leonard

Shults

et al. 2013

Inflammatory Bowel Diseases

Self Cite

View full text Add to dashboard Cite

Background and Aims Prior studies of vitamin D metabolism in Crohn disease (CD) did not include controls or examine changes following diagnosis. This study examined associations among 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D] and parathyroid hormone (PTH) levels in incident pediatric CD, compared with controls, and following diagnosis. Methods Serum vitamin D and PTH were measured at diagnosis (n = 78), 6, 12, and a median of 43 months (n = 52) later in CD participants, and once in 221 controls. Multivariate regression was used to examine baseline associations, and quasi-least squares regression to assess subsequent changes. Results At diagnosis, 42% of CD participants were 25(OH)D deficient (<20 ng/mL). The odds ratio for deficiency was 2.1 (95% CI 1.1, 3.9; p<0.05) vs. controls, adjusted for age, race, and season. 1,25(OH)2D was lower in CD vs. controls (p<0.05), adjusted for 25(OH)D, tumor necrosis factor–α (TNF-α) and PTH. TNF-α was associated with lower 1,25(OH)2D (p<0.05), and the positive association between PTH and 1,25(OH)2D in controls was absent in CD (interaction p=0.02). Among participants with 25(OH)D <30 ng/mL, CD was associated with lower PTH (p<0.05) vs. controls. Following diagnosis, 25(OH)D and 1,25(OH)2D improved (p<0.001). At the final visit, 3% were 25(OH)D deficient, PTH was no longer low relative to 25(OH)D, and 1,25(OH)2D was significantly elevated (p<0.001), compared with controls. Conclusions Incident CD was associated with 25(OH)D and 1,25(OH)2D deficiency and a relative hypoparathyroidism that resolved following diagnosis. Inflammatory cytokine suppression of PTH and renal 1-α-hyroxylase may contribute to these alterations.

show abstract

“…(1) Of these, 240 participants were enrolled in an ancillary longitudinal study with an additional visit at 12 months, as previously described. (11–13) …”

Section: Methodsmentioning

confidence: 99%

Glucocorticoid effects on changes in bone mineral density and cortical structure in childhood nephrotic syndrome

Tsampalieros

Gupta

Denburg

et al. 2012

Journal of Bone and Mineral Research

Self Cite

View full text Add to dashboard Cite

The impact of glucocorticoids (GC) on skeletal development has not been established. The objective of this study was to examine changes in volumetric BMD (vBMD) and cortical structure over one year in childhood nephrotic syndrome (NS) and to identify associations with concurrent GC exposure and growth. Fifty-six NS participants, ages 5–21 years, were enrolled a median of 4.3 (0.5, 8.1) years after diagnosis. Tibia peripheral quantitative CT (pQCT) scans were obtained at enrollment and 6 and 12 months later. Sex, race and age-specific Z-scores were generated for trabecular vBMD (TrabBMD-Z), cortical vBMD (CortBMD-Z), and cortical area (CortArea-Z) based on > 650 reference participants. CortArea-Z was further adjusted for tibia length-for-age Z-score. Quasi-least squares regression was used to identify determinants of changes in pQCT Z-scores. At enrollment, mean TrabBMD-Z (−0.54 ±1.32) was significantly lower (p=0.0001) and CortBMD-Z (0.73 ± 1.16, p<0.0001) and CortArea-Z (0.27 ± 0.91, p=0.03) significantly greater in NS, vs. reference participants, as previously described. Forty-eight (86%) participants were treated with GC over the study interval (median dose 0.29 mg/kg/day). On average, TrabBMD-Z and CortBMD-Z did not change significantly over the study interval; however, CortArea-Z decreased (p=0.003). Greater GC dose (p<0.001), lesser increases in tibia length (p<0.001) and lesser increases in CortArea-Z (p=0.003) were independently associated with greater increases in CortBMD-Z. Greater increases in tibia length were associated with greater declines in CortArea-Z (p < 0.01); this association was absent in reference participants (interaction p<0.02). In conclusion, GC therapy was associated with increases in CortBMD-Z, potentially related to suppressed bone formation and greater secondary mineralization. Conversely, greater growth and expansion of CortArea-Z (i.e. new bone formation) were associated with declines in CortBMD-Z. Greater linear growth was associated with impaired expansion of cortical area in NS. Studies are needed to determine the fracture implications of these findings.

show abstract

Bone Density and Cortical Structure after Pediatric Renal Transplantation

Cited by 36 publications

References 49 publications

Changes in bone structure and the muscle–bone unit in children with chronic kidney disease

Changes in bone structure and the muscle–bone unit in children with chronic kidney disease

Changes in Vitamin D and Parathyroid Hormone Metabolism in Incident Pediatric Crohnʼs Disease

Glucocorticoid effects on changes in bone mineral density and cortical structure in childhood nephrotic syndrome

Contact Info

Product

Resources

About