Document Detail


Rapid cortical bone loss in patients with chronic kidney disease.
MedLine Citation:
PMID:  23456850     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Thomas L Nickolas; 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
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research     Volume:  28     ISSN:  1523-4681     ISO Abbreviation:  J. Bone Miner. Res.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-22     Completed Date:  2014-02-26     Revised Date:  2014-08-04    
Medline Journal Info:
Nlm Unique ID:  8610640     Medline TA:  J Bone Miner Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1811-20     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society for Bone and Mineral Research.
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MeSH Terms
Descriptor/Qualifier:
Absorptiometry, Photon
Aged
Biological Markers / metabolism
Bone Density
Bone Remodeling
Bone Resorption / complications*,  pathology,  physiopathology,  radiography
Bone and Bones / metabolism,  pathology*,  physiopathology,  radiography
Female
Follow-Up Studies
Hormones / metabolism
Humans
Linear Models
Longitudinal Studies
Male
Organ Size
Renal Dialysis
Renal Insufficiency, Chronic / complications*,  pathology,  physiopathology,  radiography
Grant Support
ID/Acronym/Agency:
K23 DK080139/DK/NIDDK NIH HHS; K23 DK080139/DK/NIDDK NIH HHS; K23 DK084337/DK/NIDDK NIH HHS; K24 AR052665/AR/NIAMS NIH HHS; K24 AR052665/AR/NIAMS NIH HHS; UL1 TR000040/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Hormones
Comments/Corrections

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