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. 2013 Aug;28(8):1811-20.
doi: 10.1002/jbmr.1916.

Rapid cortical bone loss in patients with chronic kidney disease

Thomas L Nickolas  1 , Emily M Stein, Elzbieta Dworakowski, Kyle K Nishiyama, Mafo Komandah-Kosseh, Chiyuan A Zhang, Donald J McMahon, Xiaowei S Liu, Stephanie Boutroy, Serge Cremers, Elizabeth Shane
Affiliations

Rapid cortical bone loss in patients with chronic kidney disease

Thomas L Nickolas et al. J Bone Miner Res. 2013 Aug.

Abstract

Chronic kidney disease (CKD) patients may have high rates of bone loss and fractures, but microarchitectural and biochemical mechanisms of bone loss in CKD patients have not been fully described. In this longitudinal study of 53 patients with CKD Stages 2 to 5D, we used dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HRpQCT), and biochemical markers of bone metabolism to elucidate effects of CKD on the skeleton. Median follow-up was 1.5 years (range 0.9 to 4.3 years); bone changes were annualized and compared with baseline. By DXA, there were significant declines in areal bone mineral density (BMD) of the total hip and ultradistal radius: -1.3% (95% confidence interval [CI] -2.1 to -0.6) and -2.4% (95% CI -4.0 to -0.9), respectively. By HRpQCT at the distal radius, there were significant declines in cortical area, density, and thickness and increases in porosity: -2.9% (95% CI -3.7 to -2.2), -1.3% (95% CI -1.6 to -0.6), -2.8% (95% CI -3.6 to -1.9), and +4.2% (95% CI 2.0 to 6.4), respectively. Radius trabecular area increased significantly: +0.4% (95% CI 0.2 to 0.6), without significant changes in trabecular density or microarchitecture. Elevated time-averaged levels of parathyroid hormone (PTH) and bone turnover markers predicted cortical deterioration. Higher levels of serum 25-hydroxyvitamin D predicted decreases in trabecular network heterogeneity. These data suggest that significant cortical loss occurs with CKD, which is mediated by hyperparathyroidism and elevated turnover. Future investigations are required to determine whether these cortical losses can be attenuated by treatments that reduce PTH levels and remodeling rates.

Keywords: CHRONIC KIDNEY DISEASE; CORTICAL BONE; DXA; HRpQCT; RENAL OSTEODYSTROPHY.

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Conflict of interest statement

Disclosure:

All authors state that they have no conflicts of interest

Figures

Figure 1
Figure 1
Annual Percent Change from Baseline in areal BMD by DXA (1a) and volumetric BMD and bone geometry and microarchitecture by HRpQCT at the distal radius (1b) and tibia (1c) (Mean ± SEM). Figure 1a: Annual percent change in areal BMD Figure 1b: Annual percent change in volumetric BMD and bone geometry and microarchitecture at the radius Figure 1c: Annual percent change in volumetric BMD and bone geometry and microarchitecture at the tibia
Figure 2
Figure 2
Comparison of bone loss by DXA and HRpQCT by severity of kidney dysfunction.
See this image and copyright information in PMC

References

    1. Kaji H, Yamauchi M, Yamaguchi T, Shigematsu T, Sugimoto T. Mild Renal Dysfunction Is a Risk Factor for a Decrease in Bone Mineral Density and Vertebral Fractures in Japanese Postmenopausal Women. The Journal of clinical endocrinology and metabolism 2010 - PubMed
    1. Ball AM, Gillen DL, Sherrard D, Weiss NS, Emerson SS, Seliger SL, Kestenbaum BR, Stehman-Breen C. Risk of Hip Fracture Among Dialysis and Renal Transplant Recipients. JAMA: The Journal of the American Medical Association. 2002;288(23):3014–8. - PubMed
    1. Nickolas TL, McMahon DJ, Shane E. Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States. J AmSocNephrol. 2006;17(11):3223–32. - PubMed
    1. Fried LF, Biggs ML, Shlipak MG, Seliger S, Kestenbaum B, Stehman-Breen C, Sarnak M, Siscovick D, Harris T, Cauley J, Newman AB, Robbins J. Association of kidney function with incident hip fracture in older adults. J AmSocNephrol. 2007;18(1):282–6. - PubMed
    1. Nitsch D, Mylne A, Roderick PJ, Smeeth L, Hubbard R, Fletcher A. Chronic kidney disease and hip fracture-related mortality in older people in the UK. Nephrol Dial Transplant. 2009;24(5):1539–44. - PubMed

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