Journal of Bone and Mineral Metabolism

, Volume 29, Issue 3, pp 321–327 | Cite as

Comparative study of quantitative ultrasonography and dual-energy X-ray absorptiometry for evaluating renal osteodystrophy in children with chronic kidney disease

  • Athanasios Christoforidis
  • Nikoleta Printza
  • Chrysa Gkogka
  • Ekaterini Siomou
  • Anna Challa
  • Eirini Kazantzidou
  • Konstantinos Kollios
  • Fotis Papachristou
Original Article

Abstract

Our aim was to assess bone parameters in children with chronic kidney disease (CKD) with both dual-energy X-ray absorptiometry (DXA) and quantitative ultrasonography (QUS) and additionally with biochemical markers of bone turnover. Twenty children (12 boys and 8 girls) with CKD and a mean decimal age of 9.47 ± 4.44 years were included in the study where anthropometric parameters (height and weight), pubertal status, bone mineral density (BMD) at lumbar spine, speed of sound (SOS) measured by QUS at radius and at tibia, and biochemical markers of bone metabolism were measured. Six patients (30%) had tibial SOS Z score <−1, and 52.7% had radial SOS Z score <−1, whereas only 16.67% had BMD Z score <−1. Patients had significantly increased levels of serum intact parathormone (p < 0.001), serum bone alkaline phosphatase (BAP) (p < 0.001) and serum N-terminal-mid fragment (aminoacids 1-43) of osteocalcin (p < 0.001) compared to controls, whereas serum osteoprotegerin was significantly decreased in patients compared to controls (p = 0.001). SOS was significantly correlated to BAP (r = −0.586, p = 0.013 and r = −0.709, p = 0.001, respectively, for radius and tibia). In conclusion no association between DXA and QUS measurements was documented in our study, whereas QUS was better correlated to biochemical indices of ROD.

Keywords

Renal osteodystrophy Chronic kidney disease Dual-energy X-ray absorptiometry Quantitative ultrasonography Children 

References

  1. 1.
    Ammann P, Rizzoli R (2003) Bone strength and its determinants. Osteoporos Int 14:S13–S18PubMedCrossRefGoogle Scholar
  2. 2.
    Arici M, Erturk H, Altun B, Usalan C, Ulusoy S, Erdem Y, Sivri A, Yasavul U, Turgan C, Caglar S (2000) Bone mineral density in haemodialysis patients: a comparative study of dual-energy X-ray absorptiometry and quantitative ultrasound. Nephrol Dial Transplant 15:1847–1851PubMedCrossRefGoogle Scholar
  3. 3.
    Bacchetta J, Boutroy S, Guebre-Egziabher F, Juillard L, Drai J, Pelletier S, Richard M, Charrie A, Carlier MC, Chapurlat R, Laville M, Fouque D (2009) The relationship between adipokines, osteocalcin and bone quality in chronic kidney disease. Nephrol Dial Transplant 24:3120–3125PubMedCrossRefGoogle Scholar
  4. 4.
    Barkmann R, Lusse S, Stampa B, Sakata S, Heller M, Gluer CC (2000) Assessment of the geometry of human finger phalanges using quantitative ultrasound in vivo. Osteoporos Int 11:745–755PubMedCrossRefGoogle Scholar
  5. 5.
    Bianchi ML, Baim S, Bishop NJ, Gordon CM, Hans DB, Langman CB, Leonard MB, Kalkwarf HJ (2010) Official positions of the International Society for Clinical Densitometry (ISCD) on DXA evaluation in children and adolescents. Pediatr Nephrol 25:37–47PubMedCrossRefGoogle Scholar
  6. 6.
    Bianchi ML, Colantonio G, Montesano A, Trevisan C, Ortolani S, Rossi R, Buccianti G (1992) Bone mass status in different degrees of chronic renal failure. Bone 13:225–228PubMedCrossRefGoogle Scholar
  7. 7.
    Chiotis D, Krikos X, Tsiftis G, Hatzisymeaon M, Maniati-Christidi M, Dacou-Voutetaki A (2004) Body mass index and prevalence of obesity in subjects of Hellenic origin aged 0–18 years, living in the Athens area. Ann Clin Pediatr Univ Athen 51:139–154Google Scholar
  8. 8.
    Chiotis D, Tsiftis G, Hatzisymeon M, Maniati-Christidi M, Dacou-Voutetakis A (2003) Height and weight of children of Hellenic origin aged 0–18 years (2000–2001): comparison with data collected during the period 1978–1979. Ann Clin Pediatr Univ Athen 50:136–155Google Scholar
  9. 9.
    Christoforidis A, Papadopoulou E, Dimitriadou M, Stilpnopoulou D, Gkogka C, Katzos G, Athanassiou-Metaxa M (2009) Reference values for quantitative ultrasonography (QUS) of radius and tibia in healthy Greek pediatric population: clinical correlations. J Clin Densitom 12:360–368PubMedCrossRefGoogle Scholar
  10. 10.
    Coen G, Ballanti P, Balducci A, Calabria S, Fischer MS, Jankovic L, Manni M, Morosetti M, Moscaritolo E, Sardella D, Bonucci E (2002) Serum osteoprotegerin and renal osteodystrophy. Nephrol Dial Transplant 17:233–238PubMedCrossRefGoogle Scholar
  11. 11.
    da Costa JA, de Castro JA, Foss MC (2004) The evaluation of renal osteodystrophy with cortical quantitative ultrasound at various bone sites. Ren Fail 26:237–241PubMedCrossRefGoogle Scholar
  12. 12.
    Doumouchtsis KK, Kostakis AI, Doumouchtsis SK, Tziamalis MP, Tsigris C, Kostaki MA, Perrea DN (2007) sRANKL/osteoprotegerin complex and biochemical markers in a cohort of male and female hemodialysis patients. J Endocrinol Invest 30:762–766PubMedGoogle Scholar
  13. 13.
    Foldes AJ, Arnon E, Popovtzer MM (1996) Reduced speed of sound in tibial bone of haemodialysed patients: association with serum PTH level. Nephrol Dial Transplant 11:1318–1321PubMedGoogle Scholar
  14. 14.
    Guglielmi G, Adams J, Link TM (2009) Quantitative ultrasound in the assessment of skeletal status. Eur Radiol 19:1837–1848PubMedCrossRefGoogle Scholar
  15. 15.
    Guglielmi G, de Terlizzi F, Aucella F, Scillitani A (2006) Quantitative ultrasound technique at the phalanges in discriminating between uremic and osteoporotic patients. Eur J Radiol 60:108–114PubMedCrossRefGoogle Scholar
  16. 16.
    Haas M, Leko-Mohr Z, Roschger P, Kletzmayr J, Schwarz C, Domenig C, Zsontsich T, Klaushofer K, Delling G, Oberbauer R (2002) Osteoprotegerin and parathyroid hormone as markers of high-turnover osteodystrophy and decreased bone mineralization in hemodialysis patients. Am J Kidney Dis 39:580–586PubMedCrossRefGoogle Scholar
  17. 17.
    Jamal SA, Chase C, Goh YI, Richardson R, Hawker GA (2002) Bone density and heel ultrasound testing do not identify patients with dialysis-dependent renal failure who have had fractures. Am J Kidney Dis 39:843–849PubMedCrossRefGoogle Scholar
  18. 18.
    KDOQI (K/DOQI) (2005) Clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis 46:1–103Google Scholar
  19. 19.
    Leonard MB (2007) A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease. Pediatr Nephrol 22:1815–1824PubMedCrossRefGoogle Scholar
  20. 20.
    Lewiecki EM (2005) Update on bone density testing. Curr Osteoporos Rep 3:136–142PubMedCrossRefGoogle Scholar
  21. 21.
    Montagnani A, Gonnelli S, Cepollaro C, Martini S, Finato V, Di Paolo N, Bellucci G, Gennari C (1999) Quantitative ultrasound in the assessment of skeletal status in uremic patients. J Clin Densitom 2:389–395PubMedCrossRefGoogle Scholar
  22. 22.
    Parfitt AM (1998) A structural approach to renal bone disease. J Bone Miner Res 13:1213–1220PubMedCrossRefGoogle Scholar
  23. 23.
    Peretz A, Penaloza A, Mesquita M, Dratwa M, Verhas M, Martin P, de Maertelaer V, Bergmann P (2000) Quantitative ultrasound and dual X-ray absorptiometry measurements of the calcaneus in patients on maintenance hemodialysis. Bone 27:287–292PubMedCrossRefGoogle Scholar
  24. 24.
    Pluskiewicz W, Adamczyk P, Drozdzowska B, Szprynger K, Szczepanska M, Halaba Z, Karasek D (2003) Skeletal status in children and adolescents with chronic renal failure before onset of dialysis or on dialysis. Osteoporos Int 14:283–288PubMedCrossRefGoogle Scholar
  25. 25.
    Pluskiewicz W, Przedlacki J, Drozdzowska B, Wlodarczyk D, Matuszkiewicz-Rowinska J, Adamczyk P (2004) Quantitative ultrasound at hand phalanges in adults with end-stage renal failure. Ultrasound Med Biol 30:455–459PubMedCrossRefGoogle Scholar
  26. 26.
    Pluskiewicz W, Przedlacki J, Drozdzowska B, Wlodarczyk D, Matuszkiewicz-Rowinska J, Adamczyk P (2006) Quantitative ultrasound in monitoring of skeletal status in adults with end-stage renal disease. Ultrasound Med Biol 32:1521–1527PubMedCrossRefGoogle Scholar
  27. 27.
    Pluskiewicz W, Zywiec J, Gumprecht J, Grzeszczak W (2007) Quantitative ultrasound of phalanges of adults with end-stage renal disease or who have undergone renal transplantation. Ultrasound Med Biol 33:1353–1361PubMedCrossRefGoogle Scholar
  28. 28.
    Przedlacki J, Pluskiewicz W, Wieliczko M, Drozdzowska B, Matuszkiewicz-Rowinska J, Bogdanska-Straszynska B, Wlodarczyk D, Ostrowski K (1999) Quantitative ultrasound of phalanges and dual-energy X-ray absorptiometry of forearm and hand in patients with end-stage renal failure treated with dialysis. Osteoporos Int 10:1–6PubMedCrossRefGoogle Scholar
  29. 29.
    Rico H, Aguado F, Revilla M, Villa LF, Martin J (1994) Ultrasound bone velocity and metacarpal radiogrametry in hemodialyzed patients. Miner Electrolyte Metab 20:103–106PubMedGoogle Scholar
  30. 30.
    Sanchez CP (2006) Adynamic bone revisited: is there progress? Perit Dial Int 26:43–48PubMedGoogle Scholar
  31. 31.
    Sanchez MM, Gilsanz V (2005) Pediatric DXA bone measurements. Pediatr Endocrinol Rev 2:337–341PubMedGoogle Scholar
  32. 32.
    Shaarawy M, Fathy SA, Mehany NL, Hindy OW (2007) Circulating levels of osteoprotegerin and receptor activator of NF-kappaB ligand in patients with chronic renal failure. Clin Chem Lab Med 45:1498–1503PubMedCrossRefGoogle Scholar
  33. 33.
    Singer FR, Eyre DR (2008) Using biochemical markers of bone turnover in clinical practice. Cleve Clin J Med 75:739–750PubMedCrossRefGoogle Scholar
  34. 34.
    Swolin-Eide D, Magnusson P, Hansson S (2007) Bone mass, biochemical markers and growth in children with chronic kidney disease: a 1-year prospective study. Acta Paediatr 96:720–725PubMedCrossRefGoogle Scholar
  35. 35.
    Taal MW, Cassidy MJ, Pearson D, Green D, Masud T (1999) Usefulness of quantitative heel ultrasound compared with dual-energy X-ray absorptiometry in determining bone mineral density in chronic haemodialysis patients. Nephrol Dial Transplant 14:1917–1921PubMedCrossRefGoogle Scholar
  36. 36.
    Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 51:170–179PubMedCrossRefGoogle Scholar
  37. 37.
    Tribl B, Vogelsang H, Pohanka E, Grampp S, Gangl A, Horl WH (1998) Broadband ultrasound attenuation of the calcaneus. A tool for assessing bone status in patients with chronic renal failure. Acta Radiol 39:637–641PubMedCrossRefGoogle Scholar
  38. 38.
    Weber LT, Mehls O (2010) Limitations of dual X-ray absorptiometry in children with chronic kidney disease. Pediatr Nephrol 25:3–5PubMedCrossRefGoogle Scholar
  39. 39.
    Yamaguchi T, Kanno E, Tsubota J, Shiomi T, Nakai M, Hattori S (1996) Retrospective study on the usefulness of radius and lumbar bone density in the separation of hemodialysis patients with fractures from those without fractures. Bone 19:549–555PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer 2010

Authors and Affiliations

  • Athanasios Christoforidis
    • 1
  • Nikoleta Printza
    • 1
  • Chrysa Gkogka
    • 1
  • Ekaterini Siomou
    • 2
  • Anna Challa
    • 2
  • Eirini Kazantzidou
    • 3
  • Konstantinos Kollios
    • 4
  • Fotis Papachristou
    • 1
  1. 1.1st Paediatric DepartmentAristotle UniversityThessalonikiGreece
  2. 2.Department of Child Health, Medical SchoolUniversity of IoanninaIoanninaGreece
  3. 3.Radiology Department“Ippokratio” HospitalThessalonikiGreece
  4. 4.3rd Paediatric DepartmentAristotle UniversityThessalonikiGreece

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