Bone mineral density and bone histomorphometry in children on long-term dialysis

Andrade, Maria Cristina de; Carvalhaes, João Tomás de Abreu; Carvalho, Aluízio Barbosa de; Lazarretti-Castro, Marise; Brandão, Cynthia

doi:10.1007/s00467-007-0546-7

Cited by 27 publications

(13 citation statements)

References 21 publications

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“…Bone results in dialysis children There are few data on bone health in dialysis children but the study by Andrade et al demonstrated the inability of DXA to distinguish normal and abnormal bone histomorphometry [29]. In pQCT, Lima et al showed an increased trabecular vBMD and a decreased cortical vBMD in comparison to healthy controls in a cohort of 21 children and adolescents undergoing maintenance peritoneal dialysis [30].…”

Section: Discussionmentioning

confidence: 99%

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

et al. 2011

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Bone damage in children with chronic kidney disease (CKD) is a challenge for pediatric nephrologists. Areal measurements of bone mineral density (BMD) by dual x-ray absorptiometry (DXA) have been routinely performed to assess bone mass but recent international guidelines have concluded that DXA was of less value in CKD. The aim of this study is to evaluate bone quality in CKD children using new bone imaging techniques in a pilot cross-sectional single-center study. We performed bone imaging (high-resolution peripheral quantitative computed tomography, HR-pQCT, XtremeCT, Scanco Medical AG, Switzerland), to assess compartmental volumetric BMD and trabecular microarchitecture in 22 CKD children and 19 controls. In seven younger patients (i.e., under 10 years of age), we performed bone texture analysis (BMA, D3A Medical Systems, France) in comparison to 15 healthy prepubertal controls. Among older children, CKD patients had significantly lower height and body weight without significant impairment of BMD and microarchitecture than healthy controls. In univariate analysis, there were significant correlations between cortical BMD and glomerular filtration rate (r= -0.46), age (r=0.60) and body mass index (r=0.67). In younger children, bone texture parameters were not different between patients and controls. Our results did not show significant differences between healthy controls and CKD children for compartmental bone densities and microarchitecture, but the small sample size and the heterogeneity of the CKD group require caution in the interpretation. Novel bone imaging techniques seem feasible in children, and further longitudinal studies are required to thoroughly explore long-term cardiovascular and bone consequences of phosphate-calcium metabolism deregulation during CKD.

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Section: Discussionmentioning

confidence: 99%

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

et al. 2011

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“…Most studies of bone health in pediatric CKD used DXA and yielded inconsistent results, reporting decreased [28–32], normal [25, 33–35], or increased BMD [36, 37] compared to controls. These studies utilized varying methods to adjust for growth failure and different reference samples to generate Z-scores.…”

Section: Discussionmentioning

confidence: 99%

Assessment of dual-energy x-ray absorptiometry measures of bone health in pediatric chronic kidney disease

et al. 2012

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Background Dual-energy X-ray absorptiometry (DXA) techniques are limited in childhood chronic kidney disease (CKD) by the confounding effect of short stature and opposing parathyroid hormone effects on trabecular and cortical bone. Peripheral quantitative computed tomography (pQCT) is not subject to these limitations. Methods Lumbar spine (LS) and whole-body (WB) DXA and tibia pQCT scans were obtained in 88 stage 4–5 CKD and >650 healthy participants, ages 5–21 years. Sex- and race-specific Z-scores were generated for bone mineral density (BMD) and bone mineral content (BMC) by DXA, relative to age and adjusted for height Z-score (LS-BMD-Z and WB-BMC-Z), and compared to pQCT Z-scores for trabecular BMD (TrabBMD-Z) for age and cortical BMC (CortBMC-Z) for age and tibia length. Results LS-BMD-Z [0.50 (95% C.I. 0.28, 0.73), p<0.0001] and TrabBMD-Z [0.53 (0.27, 0.79), p<0.0001] were greater in CKD, and WB-BMC-Z [−0.36 (−0.53, −0.19), p<0.0001] and CortBMC-Z [−0.48 (−0.70, −0.27), p<0.0001] were lower, compared to reference participants. Z-scores were correlated at trabecular (LS-BMD-Z and TrabBMD-Z: R=0.36) and cortical (WB-BMC-Z and CortBMC-Z: R=0.64) sites in CKD; similar to correlations in reference participants. Conclusions Lumbar spine and whole-body DXA suggested greater trabecular BMD and lower cortical BMC in CKD, consistent with pQCT results; however, correlations were modest. Studies are needed to identify methods that predict fracture in childhood CKD.

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“…DXA measurements are limited by 2-dimensional assessment and represent mainly trabecular bone. The correlation between bone histology and DXA is suboptimal in both children and adult patients with chronic renal failure [43,44]. Currently, there are no prospective clinical studies which have evaluated the relationship between fracture risk and bone mineral density in adults and pediatric patients with renal failure.…”

Section: Assessment Of Bone Mineral Densitymentioning

confidence: 97%

Mineral metabolism and bone abnormalities in children with chronic renal failure

Sanchez

2008

Rev Endocr Metab Disord

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Abnormalities in mineral metabolism and changes in skeletal histology may contribute to growth impairment in children with chronic renal failure. Hyperphosphatemia, hypocalcemia, metabolic acidosis, alterations in vitamin D and IGF synthesis and parathyroid gland dysfunction play significant roles in the development of secondary hyperparathyroidism and subsequently, bone disease in renal failure. The recent KDIGO conference has made recommendations to consider this as a systemic disorder (chronic kidney disease-mineral bone disorder) and to standardize bone histomorphometry to include bone turnover, mineralization and volume (TMV). The use of DXA to assess bone mass is controversial in children with chronic renal failure. Questions arise regarding the accuracy of bone measurements and difficulty in data interpretation especially in children with renal failure who are not only growth retarded but often have pubertal delay and osteosclerosis. The validity and feasibility of new modalities of skeletal imaging which can detect changes in both trabecular and cortical bone are currently being investigated in children. The management of mineral abnormalities and bone disease in chronic renal failure is multifactorial. To manage hyperphosphatemia, dietary phosphate restriction accompanied by intake of calcium-free and metal-free phosphate binding agents are widely utilized. Vitamin D analogs remain the primary therapy for secondary hyperparathyroidism, although the use of the less hypercalcemic agents is preferred due to concerns of calciphylaxis and vascular calcification. Future clinical studies are needed to evaluate the long-term effects of calcimimetic agents and bisphosphonate therapy in children with chronic renal failure.

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Bone mineral density and bone histomorphometry in children on long-term dialysis

Cited by 27 publications

References 21 publications

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

Assessment of dual-energy x-ray absorptiometry measures of bone health in pediatric chronic kidney disease

Mineral metabolism and bone abnormalities in children with chronic renal failure

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