Abstract
This study was designed to characterize cortical bone by histomorphometry in a predialysis population, to correlate turnover, mineralization, and volume between cortical and trabecular bone, and to compare the findings with those in patients treated with maintenance dialysis. We evaluated cortical bone by histomorphometry in 16 patients with stage 3 or stage 4 chronic kidney disease and in 16 dialysis patients. Dual-energy X-ray absorptiometry (DXA) of the distal end of the forearm was performed in seven predialysis patients, and the findings correlated with histologic parameters. Predialysis patients compared with dialysis patients showed increased cortical bone thickness (p = 0.027) and decreased osteonal bone formation rate (p = 0.020) and adjusted apposition rate (p = 0.018), mainly for external cortical bone. In this predialysis population, trabecular bone volume positively correlated with external cortical porosity (r = 0.723, p = 0.003), external cortical thickness (r = 0.569, p = 0.034), and external osteonal accumulation (osteonal osteoid thickness, r = 0.530, p = 0.05; osteonal osteoid volume to bone volume ratio, r = 0.921, p < 0.001; and osteonal osteoid surface to bone surface ratio, r = 0.631, p = 0.016). These correlations were not observed in the internal cortical bone. Cortical osteonal mineralization surface negatively correlated with DXA Z and T scores and bone mineral density for the distal end of the forearm. The osteonal bone formation rate of both internal cortical bone and external cortical bone correlated with Z score (r = −0.975, p = 0.005 and r = −0.880, p = 0.021 respectively). We found no significant correlations between cortical thickness or porosity and DXA parameters for either external cortical bone or internal cortical bone. Our results suggest that a greater degree of kidney disease is associated with thinner cortices, eventually contributing to the higher fracture rate observed in the chronic kidney disease population. In predialysis patients, parathyroid hormone seems to have a modulating effect on both trabecular bone and cortical bone, particularly in external cortical bone.
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References
Elder G (2002) Pathophysiology and recent advances in the management of renal osteodystrophy. J Bone Miner Res 17:2094–2105
Gal-Moscovici A, Sprague SM (2008) Role of bone biopsy in stages 3 to 4 chronic kidney disease. Clin J Am Soc Nephrol 3:S170–S174
Kidney Disease: Improving Global Outcomes (KDIGO) CKD–MBD Work Group (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int 76:(Suppl 113):S1-130
Seeman E (2003) The structural and biomechanical basis of the gain and loss of bone strength in women and men. Endocrinol Metab Clin North Am 32:25–38
Jamal SA, Gilbert J, Gordon C, Bauer DC (2006) Cortical pQCT measures are associated with fractures in dialysis patients. J Bone Miner Res 21:543–548
Dooley AC, Weiss NS, Kestenbaum B (2008) Increased risk of hip fracture among men with CKD. Am J Kidney Dis 51:38–44
Fried LF, Biggs ML, Shlipak MG, Seliger S, Kestenbaum B, Stehman-Breen C, Sarnak M, Siscovick D, Harris T, Cauley J, Newman AB, Robbins J (2007) Association of kidney function with incident hip fracture in older adults. J Am Soc Nephrol 18:282–286
Carvalho CG, Pereira RC, Gales B, Salusky IB, Wesseling-Perry K (2015) Cortical and trabecular bone in pediatric end-stage kidney disease. Pediatr Nephrol 30:497–502
Carvalho C, Magalhaes J, Pereira L, Simoes-Silva L, Castro-Ferreira I, Frazao JM (2016) Evolution of bone disease after kidney transplantation: a prospective histomorphometric analysis of trabecular and cortical bone. Nephrology (Carlton) 21:55–61
Bucur RC, Panjwani DD, Turner L, Rader T, West SL, Jamal SA (2015) Low bone mineral density and fractures in stages 3–5 CKD: an updated systematic review and meta-analysis. Osteoporos Int 26:449–458
West SL, Lok CE, Langsetmo L, Cheung AM, Szabo E, Pearce D, Fusaro M, Wald R, Weinstein J, Jamal SA (2015) Bone mineral density predicts fractures in chronic kidney disease. J Bone Miner Res 30:913–919
Adragao T, Herberth J, Monier-Faugere MC, Branscum AJ, Ferreira A, Frazao JM, Malluche HH (2010) Femoral bone mineral density reflects histologically determined cortical bone volume in hemodialysis patients. Osteoporos Int 21:619–625
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470
(2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1-S266
Hernandez JD, Wesseling K, Pereira R, Gales B, Harrison R, Salusky IB (2008) Technical approach to iliac crest biopsy. Clin J Am Soc Nephrol 3:S164–S169
Dempster DW, Compston JE, Drezner MK, Glorieux FH, Kanis JA, Malluche H, Meunier PJ, Ott SM, Recker RR, Parfitt AM (2013) Standardized nomenclature, symbols, and units for bone histomorphometry: a 2012 update of the report of the ASBMR Histomorphometry Nomenclature Committee. J Bone Miner Res 28:2–17
Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G (2006) Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 69:1945–1953
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795
Kazama JJ, Matsuo K, Iwasaki Y, Fukagawa M (2015) Chronic kidney disease and bone metabolism. J Bone Miner Metab 33:245–252
Brockstedt H, Kassem M, Eriksen EF, Mosekilde L, Melsen F (1993) Age- and sex-related changes in iliac cortical bone mass and remodeling. Bone 14:681–691
Malluche HH, Mawad HW, Monier-Faugere MC (2011) Renal osteodystrophy in the first decade of the new millennium: analysis of 630 bone biopsies in black and white patients. J Bone Miner Res 26:1368–1376
Blomquist GA, Davenport DL, Mawad HW, Monier-Faugere MC, Malluche HH (2016) Diagnosis of low bone mass in CKD-5D patients. Clin Nephrol 85:77–83
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Carvalho, C., Magalhães, J., Neto, R. et al. Cortical bone analysis in a predialysis population: a comparison with a dialysis population. J Bone Miner Metab 35, 513–521 (2017). https://doi.org/10.1007/s00774-016-0781-8
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DOI: https://doi.org/10.1007/s00774-016-0781-8