The Non-invasive Diagnosis of Bone Disorders in CKD

Bover, Jordi; Ureña-Torres, Pablo; Cozzolino, Mario; Rodríguez‐García, Minerva; Gómez‐Alonso, Carlos

doi:10.1007/s00223-020-00781-5

Cited by 33 publications

(30 citation statements)

References 126 publications

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“…Furthermore, the iPTH levels in this study were within the recommended range from the international guideline, representing the well‐controlled haemodialysis patients in real‐world setting 15 . Although the total P1NP concentration depends on renal clearance, 11 we demonstrate that it can be compared within the population of haemodialysis patients with a high NPV to exclude low BMD. The bone biomarker cutoffs for the diagnosis of Q1 Z score are similar to the ones that are used to predict osteoporosis by standard T score definition, encouraging their use in the future clinical studies of early intervention in CKD patients with high fracture risk.…”

Section: Discussionmentioning

confidence: 90%

“…In this regard, bone exerts an essential role in CKD-MBD by producing bone resorption biomarkers, including tartrate-resistant acid phosphatase 5b (TRAP5b) and carboxy-terminal cross-linking telopeptide of type 1 collagen (CTX); and bone formation biomarkers, such as bone-specific alkaline phosphatase (BALP), total procollagen type 1N-terminal propeptide (P1NP), and osteocalcin. 7,[9][10][11] Previous studies revealed that increases in both bone resorption and bone formation biomarkers are associated with high bone turnover state while reductions in both bone turnover biomarkers suggest low bone turnover condition. [11][12][13] Of interest, the changes of bone turnover biomarkers generally need only weeks to months.…”

Section: Introductionmentioning

confidence: 99%

“…7,[9][10][11] Previous studies revealed that increases in both bone resorption and bone formation biomarkers are associated with high bone turnover state while reductions in both bone turnover biomarkers suggest low bone turnover condition. [11][12][13] Of interest, the changes of bone turnover biomarkers generally need only weeks to months. 6 Therefore, international guidelines have underscored DXA-derived BMD and bone turnover biomarkers as important tools for assessing bone disease in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

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Effects of phosphate binders on bone biomarkers and bone density in haemodialysis patients

et al. 2022

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Aim: The incidences of osteoporosis, fracture and vascular calcification increase concordantly with the progression of chronic kidney disease (CKD). CKD-mineral bone disease (CKD-MBD) induced by hyperphosphatemia is a major pathophysiologic mechanism. The effects of phosphate binders on bone turnover biomarkers and bone mineral density (BMD) in haemodialysis patients are still inconclusive. Our aim is to demonstrate the effects of these phosphate binders on different aspects of CKD-MBD.Methods: We conducted a prospective cohort of 65 haemodialysis patients to investigate the effect of 12-month monotherapy of phosphate binders composing calcium-based phosphate binders (CPB) or non-calcium-based phosphate binders (NCPB), including sevelamer and lanthanum, on bone turnover biomarkers and BMD changes. The performance of bone turnover biomarkers to predict low BMD was attentively determined.Results: When compared with CPB, NCPB use was associated with higher levels of bone turnover biomarkers. NCPB was also associated with lower BMD at lumbar and distal radius. Total procollagen type 1N-terminal propeptide (P1NP), bone-specific alkaline phosphatase (BALP), and tartrate-resistant acid phosphatase 5b (TRAP5b) provided the best performance for diagnosing low BMD in haemodialysis patients. Conclusion:Switching from CPB to NCPB might increase bone biomarkers and prevent the development of adynamic bone disease. On the contrary, NCPB should be cautiously used in haemodialysis patients who already had low BMD. P1NP, BALP and TRAP5b could be used to guide the appropriate management, including antiresorptive and anabolic medications, and predict low BMD in haemodialysis patients treated with phosphate binders.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of phosphate binders on bone biomarkers and bone density in haemodialysis patients

et al. 2022

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“…Key message: The evaluation of bone density in CKD patients is not always predictive of bone fragility [ 26 ]. In fact, DXA provides a two-dimensional evaluation of a three-dimensional structure and offers a very poor spatial resolution [ 34 ].…”

Section: Rod and Osteoporosismentioning

confidence: 99%

Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

Carbonare

Valenti

Giannini

et al. 2021

JCM

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The use of bone biopsy for histomorphometric analysis is a quantitative histological examination aimed at obtaining quantitative information on bone remodeling, structure and microarchitecture. The labeling with tetracycline before the procedure also allows for a dynamic analysis of the osteoblastic activity and mineralization process. In the nephrological setting, bone biopsy is indicated to confirm the diagnosis of subclinical or focal osteomalacia and to characterize the different forms of renal osteodystrophy (ROD). Even if bone biopsy is the gold standard for the diagnosis and specific classification of ROD, the use of this approach is very limited. The main reasons for this are the lack of widespread expertise in performing or interpreting bone biopsy results and the cost, invasiveness and potential pain associated with the procedure. In this regard, the sedation, in addition to local anesthesia routinely applied in Italian protocol, significantly reduces pain and ameliorates the pain perception of patients. Concerning the lack of widespread expertise, in Italy a Hub/Spokes model is proposed to standardize the analyses, optimizing the approach to CKD patients and reducing the costs of the procedure. In addition, new tools offer the possibility to evaluate the osteogenic potential or the ability to form bone under normal and pathological conditions, analyzing mesenchymal stem cells and their ability to differentiate in the osteogenic lineage. In the same way, circulating microRNAs are suggested as a tool for exploring osteogenic potential. The combination of different diagnostic approaches and the optimization of the bioptic procedure represent a concrete solution to spread the use of bone biopsy and optimize CKD patient management.

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“…One of the most important challenges in CKD osteoporosis is how to diagnose it using the same tools like in the general population. These aspects are discussed by Bover et al, and two phases need to be distinguished in the evolution of this aspect [20]. During the first phase, by the time the European, North American and global CKD-MBD guidelines were published [21][22][23], there were no data supporting that the measurement of bone mineral density (BMD) could predict bone fragility fractures in CKD, like in the general population.…”

mentioning

confidence: 99%