Osteoporosis in hemodialysis patients revisited by bone histomorphometry: A new insight into an old problem

Abstract

Osteoporosis in hemodialysis patients is associated with high morbidity and mortality and, although extensively studied by noninvasive methods, has never been assessed through bone biopsy. The aim of this study was to use histomorphometry to evaluate osteoporosis and identify factors related to its development in hemodialysis patients. We conducted a cross-sectional study involving 98 patients (35 women and 63 men; mean age: 48.4 +/- 13 years) on hemodialysis for 36.9 +/- 24.7 months. Patients were submitted to transiliac bone biopsy with double tetracycline labeling. The bone metabolism factors ionized calcium, phosphorus, bone alkaline phosphatase, deoxypyridinoline, intact parathyroid hormone, and 25(OH) vitamin D were evaluated, as were the bone remodeling cytokines osteoprotegerin (OPG), soluble receptor-activator of NF-kappabeta ligand (sRANKL) and tumor necrosis factor-alpha (TNF)alpha. Osteoporosis was defined as trabecular bone volume (BV/TV) greater than 1 s.d. below normal (men <17.4%; women <14.7%). Forty-five patients (46%) presented osteoporosis, which was correlated with white race. We found BV/TV to correlate with age, OPG/sRANKL ratio, TNFalpha levels, and length of amenorrhea. In multiple regression analysis adjusted for sex and age, length of amenorrhea, white race, and OPG/sRANKL ratio were independent determinants of BV/TV. Histomorphometric analysis demonstrated that osteoporotic patients presented normal eroded surface and low bone formation rate (BFR/BS). Osteoporosis is prevalent in hemodialysis patients. Low BFR/BS could be involved in its development, even when bone resorption is normal. Cytokines may also play a role as may traditional risk factors such as advanced age, hypogonadism, and white race.

The Relationship Between Osteoprotegerin/RANKL Axis and Arterial Stiffness in Osteopenic/Osteoporotic Renal Transplantation Recipients

“…Osteoporosis is present in both low and high-bone turnover states and bone loss begins much earlier in chronic HD patients than in general population (37). Baretto et al (37) demonstrated that OPG/RANKL ratio was higher and OPG as well as OPG/RANKL ratio correlated negatively with trabecular bone volume in osteoporotic ESRD patients. It is possible that this process could be protective against bone loss by decreasing bone resorption.…”

“…The main risk factors for this undesirable process includes advanced age, postmenopausal age, glucocorticoid treatment or chronic heparin usage (37). Osteoporosis is present in both low and high-bone turnover states and bone loss begins much earlier in chronic HD patients than in general population (37). Baretto et al (37) demonstrated that OPG/RANKL ratio was higher and OPG as well as OPG/RANKL ratio correlated negatively with trabecular bone volume in osteoporotic ESRD patients.…”

“…The main risk factors for this undesirable process includes advanced age, postmenopausal age, glucocorticoid treatment or chronic heparin usage (37). Osteoporosis is present in both low and high-bone turnover states and bone loss begins much earlier in chronic HD patients than in general population (37).…”

Manifestaciones musculo-esqueléticas en pacientes en hemodiálisis crónica

“…Se ha descrito DMO disminuida en pacientes en HDC en 46 a 81% de los pacientes (27,28). En nuestro estudio encontramos una frecuencia similar (64,8%).…”

Patologiya kostnoy sistemy pri vtorichnomgiperparatireoze u patsientov s terminal'noystadiey khronicheskoy bolezni pochek na zamestitel'noypochechnoy terapii (gemodializ) (obzor literatury)

“…по данным F. Barreto и др., остеопороз регистрирует-ся у 46% диализных пациентов [14]. при возникновении Вгпт, повышенный уровень птг активирует остеокла-сты и стимулирует деминерализацию костей, приводя к повышению метаболизма -ускорению процессов ре-зорбции и формирования костей с преобладанием ре-зорбции.…”