Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 May;98(5):1930-8.
doi: 10.1210/jc.2012-4188. Epub 2013 Apr 1.

Mineral metabolism and cortical volumetric bone mineral density in childhood chronic kidney disease

Michelle R Denburg  1 , Anne K Tsampalieros, Ian H de Boer, Justine Shults, Heidi J Kalkwarf, Babette S Zemel, Debbie Foerster, David Stokes, Mary B Leonard
Affiliations

Mineral metabolism and cortical volumetric bone mineral density in childhood chronic kidney disease

Michelle R Denburg et al. J Clin Endocrinol Metab. 2013 May.

Abstract

Context: The relationships among cortical volumetric bone mineral density (CortBMD) and comprehensive measures of mineral metabolism have not been addressed in chronic kidney disease (CKD).

Objective: The aim of the study was to identify the determinants of CortBMD in childhood CKD. A secondary objective was to assess whether CortBMD was associated with subsequent fracture.

Design and participants: This prospective cohort study included 171 children, adolescents, and young adults (aged 5-21 years) with CKD stages 2-5D at enrollment and 89 1 year later.

Outcomes: Serum measures included vitamin D [25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D (1,25(OH)₂D), 24,25-dihydroxyvitamin D], vitamin D-binding protein, intact PTH, fibroblast growth factor 23, calcium, and phosphorus. Tibia quantitative computed tomography measures of CortBMD were expressed as sex-, race-, and age-specific Z-scores based on 675 controls. Multivariable linear regression identified the independent correlates of CortBMD Z-scores and the change in CortBMD Z-scores.

Results: Lower calcium (β = .31/1 mg/dL, P = .01) and 25(OH)D (β = .18/10 ng/mL, P = .04) and higher PTH (β = -.02/10%, P = .002) and 1,25(OH)₂D (β = -.07/10%, P < .001) were independently associated with lower CortBMD Z-scores at baseline. The correlations of total, free, and bioavailable 25(OH)D with CortBMD did not differ. Higher baseline 1,25(OH)₂D (P < .05) and greater increases in PTH (P < .001) were associated with greater declines in CortBMD Z-scores. Greater increases in calcium concentrations were associated with greater increases in CortBMD Z-scores in growing children (interaction P = .009). The hazard ratio for fracture was 1.75 (95% confidence interval 1.15-2.67; P = .009) per SD lower baseline CortBMD.

Conclusions: Greater PTH and 1,25(OH)₂D and lower calcium concentrations were independently associated with baseline and progressive cortical deficits in childhood CKD. Lower CortBMD Z-score was associated with increased fracture risk.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Association between change in CortBMD Z-score and change in calcium differs by change in tibia length.
See this image and copyright information in PMC

References

    1. Tsampalieros A, Kalkwarf HJ, Wetzsteon RJ, et al. Changes in bone structure and the muscle-bone unit in children with chronic kidney disease. Kidney Int. 2013;83(3):495–502 - PMC - PubMed
    1. Jamal SA, Gilbert J, Gordon C, Bauer DC. Cortical pQCT measures are associated with fractures in dialysis patients. J Bone Miner Res. 2006;21:543–548 - PubMed
    1. Wesseling-Perry K, Pereira RC, Tseng CH, et al. Early skeletal and biochemical alterations in pediatric chronic kidney disease. Clin J Am Soc Nephrol. 2012;7:146–152 - PMC - PubMed
    1. Malluche HH, Mawad HW, Monier-Faugere MC. Renal osteodystrophy in the first decade of the new millennium: analysis of 630 bone biopsies in black and white patients. J Bone Miner Res. 2011;26:1368–1376 - PMC - PubMed
    1. Bhan I, Powe CE, Berg AH, et al. Bioavailable vitamin D is more tightly linked to mineral metabolism than total vitamin D in incident hemodialysis patients. Kidney Int. 2012;82:84–89 - PMC - PubMed

Publication types

MeSH terms