Bone turnover markers predict type of bone histomorphometry and bone mineral density in Asian chronic haemodialysis patients

• Published in: Nephrology (Carlton, Vic.) Vol. 25; no. 2; pp. 163 - 171
• Main Authors: Laowalert, Suthanit, Khotavivattana, Tanatorn, Wattanachanya, Lalita, Luangjarmekorn, Pobe, Udomkarnjananun, Suwasin, Katavetin, Pisut, Eiam‐Ong, Somchai, Praditpornsilpa, Kearkiat, Susantitaphong, Paweena
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-02-2020; Wiley Subscription Services, Inc
• Subjects: Biopsy; Bone density; Bone diseases; Bone histomorphometry; Bone mineral density; Bone turnover; bone turnover markers; Calcification; Calcification (ectopic); Coronary artery; haemodialysis; Hemodialysis; Iliac crest; Kidney diseases; Mineralization; Osteitis; Osteodystrophy; Osteoporosis; Parathyroid; Parathyroid hormone; Serum levels; haemodialysis; bone mineral density; bone histomorphometry; bone turnover markers
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13593

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
SUMMARY AT A GLANCE
The study advocates bone biopsy for accurate diagnosis of chronic kidney disease‐mineral bone disease as the authors found that abnormal bone histomorphometry, bone mineral density, and severe vascular calcification to be common among haemodialysis patients even when intact parathyroid hormone levels are close to Kidney Disease Outcomes Quality Initiative target.