Osteoprotegerin and parathyroid hormone as markers of high-turnover osteodystrophy and decreased bone mineralization in hemodialysis patients

Haas, Martin; Leko‐Mohr, Zdenka; Roschger, Paul; Kletzmayr, Josef; Schwarz, Christoph; Domenig, Christoph; Zsontsich, Thomas; Klaushofer, Klaus; Delling, G.; Oberbauer, Rainer

doi:10.1053/ajkd.2002.31409

Cited by 77 publications

(64 citation statements)

References 16 publications

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“…In current studies bone aluminium deposits could be only detectable in few patients [14,64]. Serum aluminium levels do not correlate well with aluminiuminduced bone disease [64].…”

Section: Aluminiumcontrasting

confidence: 57%

“…The spectrum of entities leading to ABD has changed somewhat since then and non-aluminium-dependent factors are predominantly responsible for ABD. Nowadays, it has become infrequent to see aluminium deposition in biopsies of ABD, because aluminium containing phosphate binders are less frequently used [13,14]. The main risk factors for ABD today are diabetes mellitus, high dietary calcium intake, peritoneal dialysis and increasing age [19,20].…”

Section: Clinical Distribution Of Rod Subtypes and Risk Factorsmentioning

confidence: 99%

“…2) [13]. Similarly, the correct identification of ROD type 2 and type 3 using a combination of PTH and osteoprotegerin can be achieved in 72% and 88% of cases, respectively [14]. Initially the numbers seem to be reasonably good, but given the therapeutic consequences of long-term therapeutic interventions with potential sideeffects carrying drugs such as bisphosphonates, one would like to decrease the number of false treatment indications below approximately one out of every five to eight patients.…”

Section: Biochemical Markers Of Rodmentioning

confidence: 99%

“…In osteomalazia or mixed ROD there are significantly lower levels of the weighted average calcium concentration in the bone specimen compared with healthy controls. Higher Ca mean levels can discriminate ROD-2 between ROD-3 [14]. In renal transplant recipients an improvement of the mean trabecular calcification (Ca mean ) could be observed after early zoledronic acid treatment [78].…”

Section: Radiological Diagnosis Of Rodmentioning

confidence: 99%

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Diagnosis of renal osteodystrophy

Schwarz

Sulzbacher

Oberbauer

2006

Eur J Clin Investigation

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The idiom renal osteodystrophy (ROD) represents a heterogeneous pattern of bone disturbances caused by chronic renal insufficiency and concomitant diseases. For the clinical decision of therapy it is most important to differentiate between high and low or adynamic turnover ROD because the therapeutically consequences of these two ends of the ROD spectrum are fundamentally different. Bone histology remains the gold standard for the exact classification of ROD. Serological markers of bone metabolism are not suited for the accurate nomenclature of ROD but are useful for the sequential follow up of ROD after a clear diagnosis has been made. Similarly, radiological diagnosis of ROD using dual energy X-ray absorptiometry (DEXA) or quantitative computer tomography scan (q-CT) is inaccurate and thus more suited for the routine follow up of established disease.Besides mineralization, bone strength and the rate of fractures are strongly determined by the architecture of the bone matrix. This information, however, is also only available on bone biopsy sections and cannot be estimated by non-invasive diagnostic methods.In summary, bone biopsy should be used more liberally for correct classification of bone disease. The sequential follow up and guidance of therapy success can be performed by non-invasive procedures such as biochemical bone marker determination in blood. X-ray imaging and densitometry is suitable only for sequential evaluation of osteoporosis.

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“…In current studies bone aluminium deposits could be only detectable in few patients [14,64]. Serum aluminium levels do not correlate well with aluminiuminduced bone disease [64].…”

Section: Aluminiumcontrasting

confidence: 57%

Section: Clinical Distribution Of Rod Subtypes and Risk Factorsmentioning

confidence: 99%

Section: Biochemical Markers Of Rodmentioning

confidence: 99%

Section: Radiological Diagnosis Of Rodmentioning

confidence: 99%

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Diagnosis of renal osteodystrophy

Schwarz

Sulzbacher

Oberbauer

2006

Eur J Clin Investigation

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“…Further research is necessary to determine the best place for cut points that will place patients into categories that make sense in terms of pathophysiology or response to therapy. Serum biochemical markers of bone formation and resorption could potentially be very helpful in determining these rates (11)(12)(13). They have not yet been validated in patients with CKD.…”

Section: Turnovermentioning

confidence: 99%

Histomorphometric Measurements of Bone Turnover, Mineralization, and Volume

Ott

2008

Clinical Journal of the American Society of Nephrology

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A recent Kidney Disease: Improving Global Outcomes report suggested that bone biopsies in patients with chronic kidney disease should be characterized by determining bone turnover, mineralization, and volume. This article focuses on the calculations and interpretation of these measurements. In most cases of renal osteodystrophy, the bone formation rate is roughly similar to the bone resorption rate; therefore, the bone formation indices can be used to describe turnover. It is important to remember that these conventions will not apply in some situations. Activation frequency should not be confused with bone formation rate or bone metabolic unit birth rate. Abnormal mineralization can be described using the osteoid volume, increased osteoid maturation time, or increased mineralization lag time. The concept of bone volume is the easiest to understand, but there is a large error from one biopsy to the next in the same person. There are some difficulties with each of the measurements, and further research in patients with chronic kidney must be done to enable a consensus to be reached about cut points to define categories within the spectrum of renal osteodystrophy and how to evaluate treatment responses.

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