Parathyroid and bone response of the diabetic patient to uremia

Abstract

Biochemical and radiologic indices of bone disease were assessed in 26 insulin-dependent diabetic patients and 28 nondiabetic patients with endstage kidney disease. The two groups were comparable in age, sex, duration of renal failure, and length of time on dialysis. Diabetic patients showed significantly lower serum calcium and immunoreactive parathyroid hormone (iPTH) levels than nondiabetic patients. iPTH was not related to total serum calcium, but was positively correlated with serum phosphorous (r = 0.37, P less than 0.05 and r = 0.54, P less than 0.005, in nondiabetic and diabetic patients, respectively). iPTH correlated with alkaline phosphatase (r = 0.59, P less than 0.0009) and calcitonin (r = 0.51, P less than 0.05) only in nondiabetic patients. Osteitis fibrosa was noted radiologically in 30% of nondiabetic patients and in none of the diabetic patients (P less than 0.03). Bone morphology in eight diabetic patients who underwent iliac bone biopsy was characterized by reduced trabecular and osteoid bone volume, no woven bone, and marked reduction in indices of bone formation and resorption. The small amount of bone and lack of osteomalacia are a unique feature of the diabetic patient with chronic renal disease. The long-term sequelae of low bone turnover and reduced circulating iPTH may present a special problem to the long term diabetic survivor on the current therapies of uremia.

The Fall and Rise of Parathyroidectomy in U.S. Hemodialysis Patients, 1992 to 2002

“…It has been reported by others that diabetic ESRD patients may have lower PTH levels than their nondiabetic counterparts and may be more susceptible to low-turnover bone disease (10,11). High-dose parenteral vitamin D is often attempted as a "final" nonsurgical strategy when parathyroidectomy is being considered (12).…”

Obesity Is Associated with Secondary Hyperparathyroidism in Men with Moderate and Severe Chronic Kidney Disease

“…Studies exploring SHPT in patients with CKD have characterized the physiologic factors governing the relationship between PTH level and other components of bone and mineral metabolism, such as calcium, phosphorus, and vitamin D, mostly in the context of alterations in these factors occurring as a function of the level of severity of CKD (11)(12)(13)(14)(15)(16). There is indication from populations without CKD that PTH levels are also influenced by various demographic (17,18), anthropometric (19), and comorbidity characteristics (20). Knowledge of such associations in patients with CKD is important, because effect modification by clinical characteristics of SHPT in CKD may have therapeutic and prognostic implications.…”

Aluminum Overload: An Easily-Ignored Problem in Dialysis Patients with Hyperparathyroidism

“…et al, 1987;Pei, Y. et al, 1993), which may be related to a lower bone turnover rate, which has been reported in type 1 diabetics before the onset of clinical renal disease (Andress, D.L. et al, 1987;Vincenti, F. et al, 1984). Therefore, because of the sometimes similar clinical manifestations of hyperparathyroidism and aluminum overload, physicians treating dialysis patients with hyperparathyroidism should consider the possibility of concurrent aluminum problems, especially in high-risk diabetic patients.…”