Osteoprotegerin and uremic osteoporosis in chronic hemodialysis patients
Osteoprotegerin (OPG) is a powerful inhibitor of osteoclast activity, and it plays an important role in bone metabolism. In hemodialysis (HD) patients, the relationship between OPG and bone mineral density (BMD) is important, but remains unclear yet. The study objective was to assess the OPG role related to uremic osteoporosis in HD patients.
This cross-sectional study has been realized on a cohort of 63 chronic HD patients. Inclusion criteria: elderly prevalent HD patients with an age over 55 years old. Exclusion criteria: previous bone disease or previous renal transplant; neoplasia; parathyroidectomy, hormone replacement therapy. The data regarding demographical and clinical characteristics, including treatments for mineral and cardiovascular complications, were recorded. Serum OPG and mineral markers levels were measured. BMD was assessed by calcaneus quantitative ultrasound; it measured broadband ultrasound attenuation, speed of sound (SOS) and stiffness index (STI).
The high OPG levels were associated with higher bone mineral density (OPG–SOS P = 0.003; R = 0.37; OPG–STI P = 0.03; R = 0.28). Malnutrition, anemia and advanced age correlated with bone demineralization. Males had higher bone density parameters than females. In patients treated with vitamin D (P = 0.005), the BMD was increased comparing to patients without these treatments.
OPG levels had directly correlated with bone mineral density parameters. Our study further confirms the critical role of OPG in the pathogenesis of uremic osteoporosis in ESRD. Whether the increased circulant OPG protect against bone loss in patients undergoing HD remains to be established.
KeywordsOsteoprotegerin Osteoporosis Hemodialysis
Compliance with ethical standards
Conflict of interest
The authors have declared that no conflict of interest exists.
- 1.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 Suppl 113:S1–S130Google Scholar
- 3.National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis (2014). http://nof.org/files/nof/public/content/file/2791/upload/919.pdf (Accessed on 16 Oct 2016)
- 4.Kanis JA on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care. In: Technical Report. UK: WHO Collaborative Centre, University of SheffieldGoogle Scholar
- 8.Iimori S, Mori Y, Akita W, Kuyama T, Takada S, Asai T, Kuwahara M, Sasaki S, Tsukamoto Y (2011) Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients—a single-center cohort study. Nephrol Dial Transplant 27:345–351CrossRefPubMedGoogle Scholar
- 11.Glüer CC, Barkmann R, Blenk T, Stewart A, Kolta S, Finigan J, Graeff C, Gablentz J, Eastell R, Reid DM, Roux C, Felsenberg D (2007) Quantitative ultrasound predicts incident vertebral and hip fractures at least as strongly as DXA: the OPUS study. J Bone Miner Res 22(Suppl 1):1075Google Scholar
- 12.Hans D, Durosier C, Kans JA, Johansson H, Schott-Pethelaz AM, Krieg MA (2008) Assessment of the 10- year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 elderly women. J Bone Miner Res 23(7):1045–1051CrossRefPubMedGoogle Scholar
- 23.Krieg MA, Barkmann R, Gonnelli S, Stewart A, Bauer DC, Barquero LR, Kaufman JJ, Lorenc R, Miller PD, Olszynski WP, Poiana C, Scott AM, Lewiecki EM, Hans D (2008) Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom 11(1):163–187CrossRefPubMedGoogle Scholar