Relationship between bone mineral density and biochemical markers of bone turnover in hemodialysis patients

Abstract

End-stage renal disease is closely associated with changes in bone and mineral metabolism. In recent times, osteoporosis has become important among hemodialysis (HD) patients. In this study, the investigators sought to evaluate the relationship between bone mineral density (BMD) and biochemical markers of bone turnover among HD patients. A total of 70 uremic patients on a maintenance HD program for at least 1 y were enrolled in the study. All patients were treated with conventional bicarbonated HD for 5 h through the use of low-flux hollow-fiber dialyzers. Bone densitometry was measured by dual energy x-ray absorptiometry in the lumbar spine (LS) and the femoral neck (FN). BMD was classified according to World Health Organization criteria on the basis of BMD T scores. Biochemical bone turnover markers such as calcium, phosphorus, ionized calcium, intact parathyroid hormone, alkaline phosphatase, plasma bicarbonate, blood pH, serum albumin, and hematocrit levels were measured before the HD session in the morning. Male patients (n=37; 52.9%; mean age, 46.2+/-17.0 y) were assigned to a single study group, and female patients (n=33; 47.1%; mean age, 44.0+/-13.1 y) to another. Mean duration of HD treatment was 33.7+/-28.5 mo in females and 33.0+/-26.0 mo in males. Among all patients, BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58 patients (82.8%) and at the FN in 45 patients (64.3%). According to BMD measurements in FN T score, 10% of patients (n=7) were osteoporotic, 54.3% (n=38), osteopenic, and 35.7% (n=25), normal. On the other hand, in LS T score, the results were 47.1% (n=33) osteoporotic, 35.7% (n=25), osteopenic, and 17.1% (n=12), normal. No statistically significant association was found in osteopenia/osteoporosis between sexes according to FN and LS T score (P=.542, P=.267, respectively). No significant relationship was noted between BMD and biochemical markers of bone turnover. A positive correlation was found between FN T scores of BMD and age (r=.413, P=.000). BMD T scores within the range of scores for osteopenia/osteoporosis were observed in 78.5% of patients at the LS and in 58.5% of patients at the FN. The investigators concluded that no correlation could be found between markers of bone turnover and bone mass measurements in both skeletal regions. LS T score results were worse than FN T score results. Elevated alkaline phosphastase levels combined with high intact parathyroid hormone levels are predictive of renal osteodystrophy but not of adynamic bone disease/osteoporosis.

Association of serum alkaline phosphatase and bone mineral density in maintenance hemodialysis patients

“…Although the distorted bone and mineral metabolism in MHD patient has been widely studied, the risk factors and predictors of decreased BMD in MHD patients are not well understood 13,14 . Given the observed association between serum AlkPhos and fracture in recent studies, 5,13 we hypothesized that the increased serum AlkPhos may be a marker of decreased BMD in MHD patients.…”

“…Although the distorted bone and mineral metabolism in MHD patient has been widely studied, the risk factors and predictors of decreased BMD in MHD patients are not well understood 13,14 . Given the observed association between serum AlkPhos and fracture in recent studies, 5,13 we hypothesized that the increased serum AlkPhos may be a marker of decreased BMD in MHD patients. To test this hypothesis, we examined the association of serum AlkPhos and BMD in a cohort of MHD patients in whom other potential correlates of renal osteodystrophy and metabolic disorders including serum parathyroid hormone (PTH) and nutritional and inflammatory markers were also examined.…”

The Osteoporotic Effect of Arteriovenous Fistula on the Ipsilateral Upper Extremity in Hemodialysis Patients

“…In other studies, no significant relationship was found between iPTH and BMD (31,34). As did Sit et al (35) in their study of 70 hemodialysis patients, and Huang GS al. (1) in their study of 63 patients who had been on hemodialysis for at least 6 months (1), we also found no relationship of BMD with calcium and phosphorous.…”

The Factors Effective on Bone Mineral Density in Peritoneal Dialysis Patients

“…Grzegorzewska et al (14) reported that elevated PTH level is important in prediction of BMD with the lowest values seen in patients with the highest PTH levels. But there are studies showing no relation (9,19,20) or negative correlation also (7,(15)(16)(17)(18). Beyond the speculations related to the geographical or racial differances, these variations may be associated to PTH level.…”