Osteodystrophy of diabetics in chronic dialysis: A histomorphometric study

Abstract

A decreased incidence of hyperparathyroidism in diabetic uremic patients has been reported, but comprehensive bone histomorphometric studies on uremic diabetic osteodistrophy are scarce. We present here the results of static and dynamic bone morphometry in 13 diabetic patients on dialysis (DCD) and their comparison with a pair-matched group of nondiabetic uremics with similar age, sex, and time on dialysis (NCDC), and with a group of 17 normals (N). Diabetic bone showed: (1) Low trabecular volume (Vt 9.9% in DCD and 22.8% in N), (2) Moderately increased remodeling values of intermediate intensity between N and NDCD values (Sf = 19.3% in DCD, 37.4% in NDCD, and 8.8 +/- 6% in N, Sr = 4.3% in DCD, 7.3% in NDCD and 2.04 +/- 0.9% in N), and (3) Moderate fibrosis (Sfib 1.2% in DCD, 12.9% in NDCD). Besides these confirmatory results, two suggestions emerged from the study: (1) The relative number of cells: osteoclast density (OI) and osteoblasts (Ob/OID) appears to be lower, not only than NDCD values but also lower than N values (OI = 0.04 c/mm. in DCD, 0.31 in NDCD, and 0.14 in N; Ob/OID = 5.58% in DCD, 14.6 in NDCD and 22.12 +/- 9% m N). (2) Dynamic behavior in tetracycline based studies disclosed the appearance of two populations of DCD: a subgroup of preserved calcification dynamics with values not quite different than the NDCD group and a subgroup with a significant derangement of mineralization with no measurable bone trabecular dynamics. This late subgroup also showed significantly lower number of Ob/OID values compared with the former with preserved calcification.(ABSTRACT TRUNCATED AT 250 WORDS)

A Role for Advanced Glycation End Products in Diminished Bone Healing in Type 1 Diabetes

“…Evidence for reduced osteoblastic activity and osteopenia has been reported in type 1 diabetes (11)(12)(13)(14)48,49). The results of the present studies indicate that type 1 diabetes impairs intramembranous bone healing, as demonstrated by our finding that the degree of healing of circular osteotomies was reduced by 40% in diabetic animals versus nondiabetic controls.…”

“…Reductions in bone mineral content (4,5), osteopenia (6), increased fracture rates (7), and delayed fracture healing (8) characterize diabetic bone disease (9,10). Osteopenia occurs in association with type 1 diabetes, and evidence of reduced osteoblast activity has reported (11)(12)(13)(14). The mechanisms that cause diabetic osteopenia have not been clearly identified.…”

CKD-MBD after kidney transplantation

“…As a result, glucocorticoid use is linked to a decrease in trabecular bone by BMD and a decrease in bone formation rate [42]. Cyclosporine increases both bone formation and bone resorption while reducing cancellous bone volume [43, 44] and sirolimus has been shown to impair longitudinal growth by disrupting VEGF and IGF-1 signaling [45]. By contrast, azathioprine appears to have minimal impact on skeletal remodeling [46].…”

Hyperglycemia induces endoplasmic reticulum stress-dependent CHOP expression in osteoblasts

“…Diabetes mellitus (DM) influences bone metabolism and contributes to bone loss (2). A histomorphometric study in DM has described low recruitment of osteoblasts and diminished mineral apposition rates with no mineralization defects (3). Animal studies have also demonstrated that bone formation was impaired in a diabetic mouse model during tibial distraction osteogenesis (4).…”