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. 2009 Feb;4(2):450-5.
doi: 10.2215/CJN.01870408. Epub 2009 Jan 21.

Low bone volume--a risk factor for coronary calcifications in hemodialysis patients

Teresa Adragao  1 , Johann Herberth, Marie-Claude Monier-Faugere, Adam J Branscum, Anibal Ferreira, Joao M Frazao, Jose Dias Curto, Hartmut H Malluche
Affiliations

Low bone volume--a risk factor for coronary calcifications in hemodialysis patients

Teresa Adragao et al. Clin J Am Soc Nephrol. 2009 Feb.

Abstract

Background and objectives: There is increasing evidence that altered bone metabolism is associated with cardiovascular calcifications in patients with stage 5 chronic kidney disease on hemodialysis (HD). This study was conducted to evaluate the association between bone volume, turnover, and coronary calcifications in HD patients.

Design, setting, participants, & measurements: In a cross-sectional study, bone biopsies and multislice computed tomography were performed in 38 HD patients. Bone volume/total volume, activation frequency, and bone formation rate/bone surface were determined by histomorphometry and coronary calcifications were quantified by Agatston scores.

Results: Prevalence of low bone turnover was 50% and of low bone volume was 16%. Among the studied traditional cardiovascular risk factors, only age was found to be associated with coronary calcifications. Lower bone volume was a significant risk factor for coronary calcifications during early years of HD, whereas this effect was not observed in patients with dialysis duration >6 yr. Histomorphometric parameters of bone turnover were not associated with coronary calcifications.

Conclusions: Low bone volume is associated with increased coronary calcifications in patients on HD.

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Figures

Figure 1.
Figure 1.
Distribution of values for bone volume/tissue volume (BV/TV), activation frequency (Ac.f.), and bone formation rate/bone surface (BFR/BS) among the Agatston (Agt.) score classes <100, 100 to 400, and >400. Box = median, 25 to 75%; T-bars = minimum and maximum values.
Figure 2.
Figure 2.
Effect of the interaction between BV/TV volume and hemodialysis (HD) duration on the odds of an Agt. score of >400. Odds ratio represents the change in the odds for an Agt. score >400 for each 1% increase in BV/TV. Vertical bars = 95% confidence interval.
Figure 3.
Figure 3.
Changes in the probabilities for (A through D) the Agt. score group <100 and (E through H) the Agt. score group >400 for different BV/TV values and ages on the basis of four different HD durations (A and E = 2 yr, B and F = 4 yr, C and G = 6 yr, D and H = 17 yr). Solid line = 30-yr-old patient; long dashed line = 50-yr-old patient; short dashed line = 75-yr-old patient.
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References

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