Risk factors for vertebral fractures in renal osteodystrophy

Atsumi, K; Kushida, Kazuhiro; Yamazaki, Kaoru; Shimizu, Satoshi; Ohmura, Akihiro; Inoue, Tetsuo

doi:10.1016/s0272-6386(99)70302-1

Cited by 300 publications

(210 citation statements)

References 17 publications

Supporting

Mentioning

186

Contrasting

Unclassified

Order By: Relevance

“…Therefore, we favor the interpretation that increased bone formation in the BMP-7-treated animals lead to a reduction in serum phosphate compared with the untreated CKD/low phosphate/calcitriol group. In summary, in this murine renal ablation model of CKD, maintenance of normal Ca, PO 4 , and PTH levels was associated with an ABD that was for the first time successfully treated with a bone anabolic factor.…”

Section: Discussionmentioning

confidence: 77%

“…In the studies reported here, we developed a strategy to analyze skeletal modeling in a mouse model of ablative kidney failure when abnormalities in Ca, PO 4 , and PTH homeostasis were avoided. The hypothesis was that in the absence of hypocalcemia, hyperphosphatemia, and elevated PTH levels, induction of kidney failure would produce abnormalities in skeletal modeling.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the presence of kidney failure would diminish renal losses of Pi in the absence of increased PTH. The expected outcome was a normal serum PO 4 . The fourth group comprised 12 CKD mice fed low-phosphate chow diet and treatment with calcitriol and BMP-7 (10 g/kg intraperitoneally once a week).…”

Section: Induction Of Ckd and Treatment Protocolmentioning

confidence: 92%

See 2 more Smart Citations

Successful Treatment of an Adynamic Bone Disorder with Bone Morphogenetic Protein-7 in a Renal Ablation Model

Lund¹,

Davies²,

Brown³

et al. 2004

Journal of the American Society of Nephrology

103

View full text Add to dashboard Cite

Abstract. An adynamic bone disorder (ABD) is an important complication of chronic kidney disease (CKD) of unknown etiology for which there is no adequate treatment. Reported is an animal model of ablative CKD complicated by an ABD characterized by the absence of secondary hyperparathyroidism and its successful treatment with a skeletal anabolic factor, bone morphogenetic protein-7 (BMP-7). Adult mice were subjected to electrocautery of the right kidney followed by left nephrectomy. Animals were randomized into groups fed normal chow or fed low-phosphate chow supplemented with calcitriol to maintain normophosphatemia in CKD. All groups were maintained on the regimens for 12 wk. Hyperphosphatemia, secondary hyperparathyroidism, and a mild osteodystrophy developed in the CKD/chow-fed group, as expected. When dietary phosphorus was restricted and calcitriol was administered in the CKD low-phosphate/calcitriol group (ABD), Ca, PO 4 , and parathyroid hormone levels were maintained normal. A significant ABD developed in the ABD group characterized by significant depressions in osteoblast number, perimeters, bone formation rates, and mineral apposition rates when compared with the sham-operated, chow-fed group. The abnormal skeletal histomorphometry was reversed by BMP-7 therapy to normal values and significantly improved from the ABD group (P Ͻ 0.05). The sham-operated low-phosphate/ calcitriol-fed control group and the CKD low-phosphate/calcitriol/BMP-7 groups had reduced phosphate levels compared with the other groups (P Ͻ 0.05). ABD produced in mice with CKD in the absence of hyperparathyroidism was successfully reversed with a bone anabolic, BMP-7, associated with a reduction in plasma phosphorus.Renal osteodystrophy is a term used to describe a heterogeneous spectrum of skeletal abnormalities found in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Renal osteodystrophy ranges from states of high bone turnover to states of low bone turnover (1-3). Predominantly hyperparathyroid bone disease results in a high turnover osteodystrophy (osteitis fibrosa), and it is considered the most prevalent bone disorder in chronic kidney disease and ESKD. Low-turnover osteodystrophy reflects the lack of capacity to produce and mineralize bone matrix and has two main histologic forms: osteomalacia and the adynamic bone disorder (ABD). The ABD is an important complication of CKD associated with high rates of bone fractures (4), impaired growth (5,6), and probably vascular calcification (7,8). There has been an increase in the prevalence of ABD in patients with ESKD on dialysis (9).The pathogenesis of the ABD is unknown. It may occur when parathyroid hormone (PTH) levels are aggressively suppressed (10). As a result, practice standards target maintaining elevated intact PTH levels (about three to five times normal) sufficient to prevent the ABD (11,12). Therapy of the ABD besides adjustment of PTH levels is not available. Because secondary hyperparathyroidism in CKD causes a distinct osteodystrophy, in...

show abstract

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful Treatment of an Adynamic Bone Disorder with Bone Morphogenetic Protein-7 in a Renal Ablation Model

Lund¹,

Davies²,

Brown³

et al. 2004

Journal of the American Society of Nephrology

103

View full text Add to dashboard Cite

show abstract

“…Early studies of DXA BMD and fracture discrimination yielded conflicting results. Atsumi et al assessed 187 hemodialysis patients and reported that each standard deviation (SD) decrease in lumbar spine BMD increased the age-adjusted odds ratio (OR) of vertebral fracture 2.0-fold (95% CI: 1.4-2.0) [49]. However, subsequent studies reported that DXA spine BMD provided poor fracture discrimination in dialysis patients and transplant recipients [50][51][52].…”

Section: Posterior-anterior Lateralmentioning

confidence: 99%

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Leonard

2007

Pediatr Nephrol

View full text Add to dashboard Cite

Children with chronic kidney disease (CKD) have multiple risk factors for impaired accretion of trabecular and cortical bone. CKD during childhood poses an immediate fracture risk and compromises adult bone mass, resulting in significantly greater skeletal fragility throughout life. Highturnover disease initially results in thickened trabeculae, with greater bone volume. As disease progresses, resorption cavities dissect trabeculae, connectivity degrades, and bone volume decreases. Increased bone turnover also results in increased cortical porosity and decreased cortical thickness. Dual-energy X-ray absorptiometry (DXA)-based measures of bone mineral density (BMD) are derived from the total bone mass within the projected bone area (g/cm 2 ), concealing distinct disease effects in trabecular and cortical bone. In contrast, peripheral quantitative computed tomography (pQCT) estimates volumetric BMD (vBMD, g/cm 3 ), distinguishes between cortical and trabecular bone, and provides accurate estimates of cortical dimensions. Recent data have confirmed that pQCT measures of cortical vBMD and thickness provide substantially greater fracture discrimination in adult dialysis patients compared with hip or spine DXA. The following review considers the structural effects of renal osteodystrophy as it relates to fracture risk and the potential advantages and disadvantages of DXA and alternative measures of bone density, geometry, and microarchitecture, such as pQCT, micro-CT (μCT), and micro magnetic resonance imaging (μMRI) for fracture risk assessment.

show abstract

“…Düflük kemik kütlesine sahip ileri evre böbrek hastal›¤› olanlarda genellikle frajilite k›r›¤› insidans› yük-sektir. Ayr›ca diyaliz hastalar›nda kalça k›r›klar› daha erken yafllarda görülmekte ve genel topluma göre daha yüksek mortaliteye sebep olmaktad›r (28). Bu nedenle hemodiyaliz hastalar›nda osteopeni varl›¤›nda klinisyenlerin kemik sa¤l›¤›na daha fazla dikkat göstermeleri gerekmektedir.…”

Section: G Gi Ir Ri Ifl Flunclassified

Evaluation of Bone Mineral Density in Hemodialysis Patients

Özdemir¹,

Bilgic²

2010

tftr

View full text Add to dashboard Cite

Ö Öz ze et tA Am ma aç ç: : ‹leri evre böbrek hastal›¤› olan hastalarda, özellikle hemodiyaliz uygulananlarda, düflük kemik kütlesi frajilite k›r›klar› gibi ciddi sa¤l›k sorunlar›na yol açabilir ve hastalar›n yaflam kalitesi üzerinde olumsuz etkileri olabilir. Bu çal›flman›n amac› bir grup hemodiyaliz hastas›nda kemik mineral yo¤unlu¤unu (KMY) belirlemek ve baz› klinik parametreler ve biyokimyasal kemik döngüsü belirleyicileri aras›ndaki iliflkileri de¤erlendir-mektir. G Ge er re eç ç v ve e Y Yö ön nt te em m: : Çal›flmaya yafl ortalamas› 49,1±16,4 y›l olan 30 hemodiyaliz hastas› dahil edildi. KMY ölçümleri lomber vertebralardan (L2-L4) ve femur boynundan dual enerji X-ray absorbsiyometri (DXA) kullan›larak gerçeklefltirildi. Hemodiyaliz seans› öncesinde kalsiyum, fosfor, alkalen fosfataz, intakt paratiroid hormon (iPTH) gibi biyokimyasal kemik döngüsü belirleyicileri ve plazma bikarbonat, kan pH's›, serum albümin ve hematokrit seviyeleri gibi biyokimyasal kemik döngüsü belirleyicileri ölçüldü. B Bu ul lg gu ul la ar r: : Hastalar›n ortalama lomber vertebra ve femur boynu T-skorlar› s›ras›yla -1,6±0,8 ve -2,6±1,1 idi. Dünya Sa¤l›k Örgütü'nün KMY T-skorlar›-na dayanan kriterlerine göre lomber vertebralarda, hastalar›n %7'si osteoporotik, %60'› osteopenik, %33'ü normaldi. Di¤er taraftan, femur boynunda sonuçlar %50 osteoporotik, %40 osteopenik ve %10 normal fleklindeydi. Femur boynu osteoporotik olanlarla olmayanlar aras›nda yafl, diyaliz süresi ve iPTH seviyeleri bak›m›ndan belirgin fark gözlenmedi. Her iki bölgenin KMY ile hastalar›n yafllar›, diyaliz süreleri ve serum kalsiyum, fosfor, alkalen fosfataz, iPTH de¤erleri aras›nda herhangi bir korelasyon bulunmad›. Her iki cins aras›nda KMY ve biyokimyasal kemik döngüsü belirleyicileri bak›m›ndan istatistiksel olarak anlaml› bir fark yoktu. S So on nu uç ç: : Biz bu çal›flmada hemodiyalize giren hastalar›n %53'ünde özellik-le femur boynunda olmak üzere osteoporozun oldu¤unu tespit ettik. Bu nedenle, kronik hemodiyaliz hastalar›nda kemik sa¤l›¤›n›n iyilefltirilmesi amac›yla femur boynu KMY ölçümlerinin düzenli aral›klarla yap›lmas›n› öneriyoruz. Türk Fiz T›p Rehab Derg 2010;56:62-6. A An na ah ht ta ar r K Ke el li im me el le er r: : Hemodiyaliz, osteoporoz, kemik mineral yo¤unlu¤u, DXA S Su um mm ma ar ry y O Ob bj je ec ct ti iv ve e: : Low bone mass in end-stage renal disease patients, especially those undergoing hemodialysis, can lead to serious health problems such as fragility fractures and may have negative impact on their quality of life. The aim of this study was to determine bone mineral density (BMD) in a group of hemodialysis patients and to evaluate its relationship with several clinical parameters and markers of biochemical bone turnover. M Ma at te er ri ia al ls s a an nd d M Me et th ho od ds s: : Thirty hemodialysis patients, with a mean age of 49.7±16.0 years, were included in the study. The BMD was measured at the lumbar spine (L2-L4) and at the proximal femur by dual-energy X-ray absorptiometry (DXA). Markers of biochemical bone turnover such ...

show abstract

Risk factors for vertebral fractures in renal osteodystrophy

Cited by 300 publications

References 17 publications

Successful Treatment of an Adynamic Bone Disorder with Bone Morphogenetic Protein-7 in a Renal Ablation Model

Successful Treatment of an Adynamic Bone Disorder with Bone Morphogenetic Protein-7 in a Renal Ablation Model

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Evaluation of Bone Mineral Density in Hemodialysis Patients

Contact Info

Product

Resources

About