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Bone mineral density and parathyroid function in patients on maintenance hemodialysis

  • Nephrology - Original Paper
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Abstract

Background

The relationship between parathyroid function, an important determinant of bone turnover, and bone mineral density (BMD) in patients with chronic kidney disease is not fully understood. We wanted to analyze the association between BMD and parathyroid function in hemodialysis patients in details.

Methods

In a cross-sectional design, data from 270 patients (age 55 ± 15 years, 60% men, all Caucasian) on maintenance hemodialysis were analyzed. All patients underwent dual energy X-ray absorptiometry of the lumbar spine (LS), femoral neck (FN) and distal radius (DR). In addition to routine laboratory tests, blood samples were collected for iPTH, serum markers of bone metabolism (alkaline phosphatase, type I collagen crosslinked-C-telopeptide) and 25OH vitamin D.

Results

Based on Z-scores, bone mineral density was moderately reduced only at the femoral neck in the total cohort. The average Z-score of the “low PTH” group (iPTH < 100 pg/ml) was not different from the Z-score of patients with iPTH in the “target range” (100–300 pg/ml) at any measurement site. While iPTH was negatively correlated with BMD at all measurement sites in patients with iPTH > 100 pg/ml (rho = −0.255, −0.278 and −0.251 for LS, FN and DR, respectively, P < 0.001 for all), BMD was independent of iPTH in patients with iPTH < 100 pg/ml. Furthermore, iPTH was not associated with serum markers of bone metabolism, but these markers were negatively correlated with BMD in the “low PTH” group.

Conclusions

Low PTH levels are not associated with low BMD in patients with end-stage kidney disease. Furthermore, bone metabolism seems to be independent of iPTH in patients with relative hypoparathyroidism likely reflecting skeletal resistance to PTH.

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References

  1. Moe SM et al (2007) Chronic kidney disease-mineral-bone disorder: a new paradigm. Adv Chronic Kidney Dis 14(1):3–12

    Article  PubMed  Google Scholar 

  2. Moe S et al (2006) Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int 69(11):1945–1953

    Article  PubMed  CAS  Google Scholar 

  3. Johansen KL, Chertow GM (2007) Chronic kidney disease mineral bone disorder and health-related quality of life among incident end-stage renal-disease patients. J Ren Nutr 17(5):305–313

    Article  PubMed  Google Scholar 

  4. Mittalhenkle A, Gillen DL, Stehman-Breen CO (2004) Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis 44(4):672–679

    PubMed  Google Scholar 

  5. Toussaint ND et al (2008) Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease. Nephrol Dial Transplant 23(2):586–593

    Article  PubMed  Google Scholar 

  6. Ersoy FF (2007) Osteoporosis in the elderly with chronic kidney disease. Int Urol Nephrol 39(1):321–331

    Article  PubMed  Google Scholar 

  7. Alem AM et al (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58(1):396–399

    Article  PubMed  CAS  Google Scholar 

  8. Jadoul M et al (2006) Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the dialysis outcomes and practice patterns study. Kidney Int 70(7):1358–1366

    Article  PubMed  CAS  Google Scholar 

  9. Urena P et al (2003) Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 18(11):2325–2331

    Article  PubMed  CAS  Google Scholar 

  10. Jamal SA, Hayden JA, Beyene J (2007) Low bone mineral density and fractures in long-term hemodialysis patients: a meta-analysis. Am J Kidney Dis 49(5):674–681

    Article  PubMed  Google Scholar 

  11. Ersoy FF et al (2006) Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients. J Bone Miner Metab 24(1):79–86

    Article  PubMed  Google Scholar 

  12. Gerakis A et al (2000) Correlation of bone mineral density with the histological findings of renal osteodystrophy in patients on hemodialysis. J Nephrol 13(6):437–443

    PubMed  CAS  Google Scholar 

  13. Jamal SA et al (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(4):843–849

    Article  PubMed  Google Scholar 

  14. Merino JL et al (2004) Changes in bone mineral density during the first year of dialysis treatment. Int Urol Nephrol 36(2):285–286

    Article  PubMed  Google Scholar 

  15. Cunningham J et al (2004) Osteoporosis in chronic kidney disease. Am J Kidney Dis 43(3):566–571

    Article  PubMed  Google Scholar 

  16. Barreto FC et al (2006) Osteoporosis in hemodialysis patients revisited by bone histomorphometry: a new insight into an old problem. Kidney Int 69(10):1852–1857

    Article  PubMed  CAS  Google Scholar 

  17. Martin KJ et al (2004) Diagnosis, assessment, and treatment of bone turnover abnormalities in renal osteodystrophy. Am J Kidney Dis 43(3):558–565

    Article  PubMed  Google Scholar 

  18. Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36(6):1115–1121

    Article  PubMed  CAS  Google Scholar 

  19. Danese MD et al (2006) PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis 47(1):149–156

    Article  PubMed  Google Scholar 

  20. Wang M et al (1995) Relationship between intact 1–84 parathyroid hormone and bone histomorphometric parameters in dialysis patients without aluminum toxicity. Am J Kidney Dis 26(5):836–844

    Article  PubMed  CAS  Google Scholar 

  21. Eeckhout E et al (1989) Monitoring of bone mineral content in patients on regular hemodialysis. Nephron 52(2):158–161

    Article  PubMed  CAS  Google Scholar 

  22. Lechleitner P et al (1994) Bone mineral densitometry in dialyzed patients: quantitative computed tomography versus dual photon absorptiometry. Bone 15(4):387–391

    Article  PubMed  CAS  Google Scholar 

  23. Taal MW et al (1999) Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant 14(8):1922–1928

    Article  PubMed  CAS  Google Scholar 

  24. Kleinbaum DG, Kupper LL, Muller KE, Nizam A (eds) (1998) Applied regression analysis and other multivariable methods, 3rd edn. Duxbury Press, Pacific Grove, pp 281–316

    Google Scholar 

  25. Atsumi K et al (1999) Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis 33(2):287–293

    Article  PubMed  CAS  Google Scholar 

  26. Dolgos S et al (2008) Determinants of bone mass in end-stage renal failure patients at the time of kidney transplantation. Clin Transpl 22(4):462–468

    Article  Google Scholar 

  27. Guh JY et al (2002) Risk factors and risk for mortality of mild hypoparathyroidism in hemodialysis patients. Am J Kidney Dis 39(6):1245–1254

    Article  PubMed  Google Scholar 

  28. London GM et al (2003) Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transpl 18(9):1731–1740

    Article  Google Scholar 

  29. London GM et al (2004) Arterial calcifications and bone histomorphometry in end-stage renal disease. J Am Soc Nephrol 15(7):1943–1951

    Article  PubMed  Google Scholar 

  30. Spasovski GB (2007) Bone health and vascular calcification relationships in chronic kidney disease. Int Urol Nephrol 39(4):1209–1216

    Article  PubMed  CAS  Google Scholar 

  31. Torres A et al (1995) Bone disease in predialysis, hemodialysis, and CAPD patients: evidence of a better bone response to PTH. Kidney Int 47(5):1434–1442

    Article  PubMed  CAS  Google Scholar 

  32. Hutchison AJ et al (1993) Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease. Kidney Int 44(5):1071–1077

    Article  PubMed  CAS  Google Scholar 

  33. Gerakis A et al (1996) Biochemical markers for non-invasive diagnosis of hyperparathyroid bone disease and adynamic bone in patients on haemodialysis. Nephrol Dial Transpl 11(12):2430–2438

    CAS  Google Scholar 

  34. Quarles LD, Lobaugh B, Murphy G (1992) Intact parathyroid hormone overestimates the presence and severity of parathyroid-mediated osseous abnormalities in uremia. J Clin Endocrinol Metab 75(1):145–150

    Article  PubMed  CAS  Google Scholar 

  35. Monge M et al (2006) Reappraisal of 2003 NKF-K/DOQI guidelines for management of hyperparathyroidism in chronic kidney disease patients. Nat Clin Pract Nephrol 2(6):326–336

    Article  PubMed  CAS  Google Scholar 

  36. Shahapuni I et al (2005) How do calcimimetics fit into the management of parathyroid hormone, calcium, and phosphate disturbances in dialysis patients? Semin Dial 18(3):226–238

    Article  PubMed  Google Scholar 

  37. Fournier A et al (1997) The clinical significance of adynamic bone disease in uremia. Adv Nephrol Necker Hosp 27:131–166

    PubMed  CAS  Google Scholar 

  38. Ghazali A et al (1999) Is low plasma 25-(OH)vitamin D a major risk factor for hyperparathyroidism and Looser’s zones independent of calcitriol? Kidney Int 55(6):2169–2177

    Article  PubMed  CAS  Google Scholar 

  39. Jean G et al (2008) Daily oral 25-hydroxycholecalciferol supplementation for vitamin D deficiency in haemodialysis patients: effects on mineral metabolism and bone markers. Nephrol Dial Transpl 23(11):3670–3676

    Article  CAS  Google Scholar 

  40. Ueda M et al (2005) Serum BAP as the clinically useful marker for predicting BMD reduction in diabetic hemodialysis patients with low PTH. Life Sci 77(10):1130–1139

    Article  PubMed  CAS  Google Scholar 

  41. Drueke TB (1996) Abnormal skeletal response to parathyroid hormone and the expression of its receptor in chronic uremia. Pediatr Nephrol 10(3):348–350

    PubMed  CAS  Google Scholar 

  42. Urena P et al (1996) PTH/PTHrP receptor mRNA is down-regulated in epiphyseal cartilage growth plate of uraemic rats. Nephrol Dial Transpl 11(10):2008–2016

    CAS  Google Scholar 

  43. Slatopolsky E et al (2000) A novel mechanism for skeletal resistance in uremia. Kidney Int 58(2):753–761

    PubMed  CAS  Google Scholar 

  44. Lehmann G et al (2005) Specific measurement of PTH (1–84) in various forms of renal osteodystrophy (ROD) as assessed by bone histomorphometry. Kidney Int 68(3):1206–1214

    Article  PubMed  CAS  Google Scholar 

  45. Sneve M et al (2008) The association between serum parathyroid hormone and bone mineral density, and the impact of smoking: the Tromso study. Eur J Endocrinol 158(3):401–409

    Article  PubMed  CAS  Google Scholar 

  46. Pei Y et al (1993) Renal osteodystrophy in diabetic patients. Kidney Int 44(1):159–164

    Article  PubMed  CAS  Google Scholar 

  47. van Daele PL et al (1995) Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam study. Ann Intern Med 122(6):409–414

    PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by grant from the ETT of the Ministry of Health (172/2006), the Hungarian Kidney Foundation and the Foundation for Prevention in Medicine. This paper was supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences (Miklos Zsolt Molnar).

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Authors and Affiliations

  1. 1st Department of Internal Medicine, Semmelweis University, 2/a Koranyi S. u., 1083, Budapest, Hungary

    Cs. Ambrus, Cs. Almasi, Gy. Deak, A. Marton, Zs. Nemeth, Cs. Horvath, P. Lakatos, M. Szathmari & I. Mucsi

  2. Division of Nephrology, University of Toronto, University Health Network, Toronto, ON, Canada

    Cs. Ambrus

  3. Fresenius Medical Care, Dialysis Center, Semmelweis University, Budapest, Hungary

    K. Berta

  4. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary

    M. Zs. Molnar

  5. Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary

    I. Mucsi

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  1. Cs. Ambrus
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Correspondence to I. Mucsi.

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Ambrus, C., Almasi, C., Berta, K. et al. Bone mineral density and parathyroid function in patients on maintenance hemodialysis. Int Urol Nephrol 43, 191–201 (2011). https://doi.org/10.1007/s11255-009-9702-2

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  • DOI: https://doi.org/10.1007/s11255-009-9702-2

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