Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients

Ureña, Pablo; Bernard-Poenaru, Oana; Ostertag, Agnès; Baudoin, Claude; Cohen‐Solal, Martine; Cantor, Tom; Vernejoul, M. C. De

doi:10.1093/ndt/gfg403

Cited by 149 publications

(130 citation statements)

References 22 publications

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“…Specifically, bone with low turnover is associated with microstructural abnormalities, whereas bone with high turnover is associated with material and mechanical property abnormalities. Reduced bone quality of patients with either low-or high-turnover ROD may contribute to the known decreased mechanical competence in these patients [8][9][10][11][12][13][14] but for two different turnover-dependent reasons. These findings call for additional studies to evaluate modified treatment regimens for ROD by using tailored therapies for patients with low-or high-turnover bone.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported to occur with abnormal turnover. [8][9][10][11][12][13][14] Thus, the specific aim of this study was to advance the understanding of this potential link by quantifying how the microstructural parameters, material composition, and nanomechanical properties vary in bone with low-or high-turnover renal osteodystrophy (ROD) compared with bone with normal turnover from normal volunteers. …”

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confidence: 99%

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Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

Malluche

Porter

Monier‐Faugere

et al. 2012

Journal of the American Society of Nephrology

114

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Abnormal bone turnover is common in CKD, but its effects on bone quality remain unclear. We qualitatively screened iliac crest bone specimens from patients on dialysis to identify those patients with low (n=18) or high (n=17) bone turnover. In addition, we obtained control bone specimens from 12 healthy volunteers with normal kidney function. In the patient and control specimens, Fourier transform infrared spectroscopy and nanoindentation quantified the material and mechanical properties of the specimens, and we used bone histomorphometry to assess parameters of bone microstructure and bone formation and resorption. Compared with high or normal turnover, bone with low turnover had microstructural abnormalities such as lower cancellous bone volume and reduced trabecular thickness. Compared with normal or low turnover, bone with high turnover had material and nanomechanical abnormalities such as reduced mineral to matrix ratio and lower stiffness. These data suggest that turnover-related alterations in bone quality may contribute to the diminished mechanical competence of bone in CKD, albeit through different mechanisms. Therapies tailored specifically to low-or high-turnover bone may treat renal osteodystrophy more effectively. Bone turnover abnormalities are well known in patients with chronic kidney disease (CKD). 1 These abnormalities encompass a spectrum from severely suppressed to markedly elevated bone turnover. Abnormal bone turnover occurs in approximately 85% of patients with CKD stage 5 on dialysis (CKD-5D), 2 and within this patient group, there is a greater risk of bone fracture than within the general population. [3][4][5] Although turnover abnormalities are well described, 1 little information is available on whether these abnormalities are associated with changes in bone quality. Bone quality is the contemporary term used to refer to the structural and material parameters that collectively enable bone to bear load and resist fracture or excessive deformation. 6,7 The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported to occur with abnormal turnover. [8][9][10][11][12][13][14] Thus, the specific aim of this study was to advance the understanding of this potential link by quantifying how the microstructural parameters, material composition, and nanomechanical properties vary in bone with low-or high-turnover renal osteodystrophy (ROD) compared with bone with normal turnover from normal volunteers. RESULTSAmong 163 iliac crest bone biopsies sequentially screened from patients with CKD-5D on dialysis, 35

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

Malluche

Porter

Monier‐Faugere

et al. 2012

Journal of the American Society of Nephrology

114

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“…Moreover, CKD patients show different patterns of bone loss. Whereas some patients have a minimal bone loss, others show rapid bone losses 86. Additionally, the presence of aorta calcification and spinal osteoarthritis may bias BMD measurement,88 being the hip and the radius better sites for the BMD assessment.…”

Section: Bone and Musculoskeletal Abnormalities In Chronic Kidney Dismentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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“…Cumulative corticosteroid dosage was not associated with increased fracture risk in this analysis. Finally, it has been shown that BMD at the distal radius is predictive of fracture risk and correlates with parathyroid hormone (PTH) levels in patients who have CKD 5 and are on hemodialysis (16).…”

Section: Is There An Increased Fracture Risk After a Kidney Transplant?mentioning

confidence: 99%

Bone Disease after Renal Transplantation

Weisinger¹,

Carlini²,

Rojas³

et al. 2006

Clinical Journal of the American Society of Nephrology

121

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It has been well established that a rapid decrease in bone mineral density (BMD) occurs in the first 6 to 12 mo after a successful renal transplantation and persists, albeit at a lower rate, for many years. This rapid BMD loss significantly increases the fracture risk of these patients to levels that are even higher than those of patients who have chronic kidney disease stage 5 and are on dialysis. The presence of low BMD in renal transplant patients as a predictor of risk fracture is controversial. Indeed, as has been suggested also for patients with postmenopausal osteoporosis, there is not a compelling correlation between the decline in BMD and skeletal fractures. However, bone disease after renal transplantation probably represents a unique bone disorder that must encompass underlying renal osteodystrophy. In fact, this syndrome results from multiple factors that include pretransplantation bone status, use of glucocorticoids and other immunosuppressive drugs, hypophosphatemia, and alterations of the calcium-vitamin D axis. Recent studies have demonstrated decreased osteoblast number, reduced bone formation rate, delayed mineralization, and increased osteoblast and osteocyte apoptosis. Bisphosphonates and vitamin D metabolites may be valuable in preventing or diminishing early bone loss. However, clinicians should be careful with the use of bisphosphonates and oversuppression of bone, especially in patients with low bone turnover. New prospective, controlled trials are required to confirm the real efficacy of these drugs, particularly in long-term renal transplant patients.Clin J Am Soc Nephrol 1: 1300 -1313, 2006. doi: 10.2215/CJN.01510506 K idney, heart, lung, and liver transplantation have become fairly common and successful. As the number of transplants has grown, new challenges have arisen in the management of long-term complications of transplantation. Posttransplantation bone disease represents one such important complication, because it is observed in a substantial proportion of patients. As a consequence, bone mass loss and bone fractures are common in these patients and cause substantial morbidity.In patients with chronic kidney disease (CKD), renal osteodystrophy that begins during the early stages of the disease usually worsens during dialysis and may persist after transplantation, although in many patients, improvement in these bone lesions are observed. In addition to preexisting bone lesions, not only factors that hamper recovery but also new factors could affect bone structure after transplantation. These include the potential deleterious effects on bone of the different immunosuppressive agents, the impaired renal function that frequently is observed in renal transplant patients, and several others factors that are particular to each patient, such as postmenopausal status, presence of diabetes, gender, and time after transplantation. Changes in Bone Mineral DensityBone mineral density (BMD) as assessed by dual x-ray absorptiometry has been used as a noninvasive method to assess bone mass loss...

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Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients

Cited by 149 publications

References 22 publications

Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Bone Disease after Renal Transplantation

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