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Bone turnover markers predict type of bone histomorphometry and bone mineral density in Asian chronic haemodialysis patients
Author(s) -
Laowalert Suthanit,
Khotavivattana Tanatorn,
Wattanachanya Lalita,
Luangjarmekorn Pobe,
Udomkarnjananun Suwasin,
Katavetin Pisut,
EiamOng Somchai,
Praditpornsilpa Kearkiat,
Susantitaphong Paweena
Publication year - 2020
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13593
Subject(s) - medicine , bone remodeling , renal osteodystrophy , bone mineral , bone histomorphometry , parathyroid hormone , kidney disease , osteoporosis , urology , iliac crest , endocrinology , hyperparathyroidism , surgery , calcium , trabecular bone
ABSTRACT Background Although the levels of intact parathyroid hormone (iPTH) are well‐controlled following the Kidney Disease Outcomes Quality Initiative guideline, the incidence of osteoporosis and fracture are still high in haemodialysis (HD) patients. This study was conducted to investigate the correlation between bone turnover markers, bone mineral density (BMD), and bone histomorphometry in HD patients. Methods Twenty‐two chronic HD patients were enrolled. Serum levels of bone turnover markers were measured. Double tetracycline‐labelled iliac crest bone specimens were evaluated using specialized a computer program (Osteomeasure). The types of bone histomorphometry were classified based on turnover, mineralization and volume. BMD and coronary artery calcification were also determined. Results Bone histomorphometry revealed osteitis fibrosa (50%), adynamic bone disease (45%) and mixed uremic osteodystrophy (5%). Serum iPTH level predicted high bone turnover with area under the receiver operating characteristic (ROC) of 0.833 (95% CI = 0.665–1.000, P = 0.008). Serum TRAP‐5b also had ROC of 0.733 (95% CI = 0.517–0.950, P = 0.065). In addition, when using serum iPTH (cut‐off 484.50 ng/mL) or serum TRAP‐5b (cut‐off 1.91 pg./mL) to predict high turnover, the sensitivity was 0.917. On the other hand, when both iPTH and TRAP‐5B were above these cut‐off, the specificity was 1.000. Low BMD and severe vascular calcification were commonly identified. However, there were no significant correlations between bone biomarkers and BMD or severe vascular calcification. Conclusion Although iPTH levels were close to the target of Kidney Disease Outcomes Quality Initiative guideline, abnormal bone histomorphometry, BMD, and severe vascular calcification are still common. Bone biopsy is still crucially required as an accurate diagnostic tool in providing optimal guide for the treatment. © 2019 Asian Pacific Society of Nephrology