Original InvestigationsOsteoprotegerin and parathyroid hormone as markers of high-turnover osteodystrophy and decreased bone mineralization in hemodialysis patients*,**,*
Section snippets
Patients
Twenty-six patients (11 women; age, 56 ± 21 years) on maintenance hemodialysis therapy for a median of 38 months (interquartile range, 9 to 67 months) were recruited immediately before kidney transplantation, after informed consent was obtained. These patients were taking part in an ongoing randomized controlled trial of bisphosphonate versus placebo therapy in posttransplantation osteodystrophy, in which 32 patients were calculated to be necessary to detect a 40% difference in bone resorption
OPG
The median OPG plasma level in patients on hemodialysis therapy was significantly greater than that in age- and sex-matched healthy controls (Table 1).After dividing patients into ROD types II and III according to histomorphometric results, we found significantly lower OPG levels in patients with high-turnover bone disease compared with those with ROD II (Table 1). Moreover, there was a trend toward a negative correlation between OPG and osteoblast and osteoclast surface area (r = 0.42; P =
Discussion
We investigated biochemical markers of bone turnover to accurately diagnose ROD and mineralization deficiency in patients on maintenance hemodialysis therapy. OPG in combination with iPTH are the best biochemical markers to discriminate between ROD II and III. In addition, OPG can be used as a noninvasive measure for the diagnosis of trabecular bone mineralization. Other noninvasive, but widely used, diagnostic procedures, such as DEXA, were not helpful in the diagnosis and discrimination of
Acknowledgements
The authors thank Sonja Grois and Phaedra Messmer (Ludwig Boltzmann Institute of Osteology, Vienna) for expert technical assistance.
References (26)
- et al.
Three-dimensional analysis of the spine in autopsy cases with renal osteodystrophy
Kidney Int
(1994) - et al.
Validation of quantitative backscattered electron imaging for the measurement of mineral density distribution in human bone biopsies
Bone
(1998) - et al.
A comparison of quantitative computed tomography and dual x-ray absorptiometry for evaluation of bone mineral density in patients on chronic hemodialysis
Am J Kidney Dis
(2001) - et al.
Bone histomorphometry in hemodialysed patients
Metab Bone Dis Relat Res
(1981) - et al.
The spectrum of bone disease in end-stage renal failure—An evolving disorder
Kidney Int
(1993) - et al.
Predictive value of serum parathyroid hormone levels for bone turnover in patients on chronic maintenance dialysis
Am J Kidney Dis
(1995) - et al.
The spectrum of bone disease in 200 chronic hemodialysis patients: A correlation between clinical, biochemical and histological findings
Rev Paul Med
(1998) Osteodystrophy of diabetics in chronic dialysis: A histomorphometric study
Calcif Tissue Int
(1989)- et al.
Bone histomorphometry is still the golden standard for diagnosing renal osteodystrophy
Clin Nephrol
(2000) - et al.
Measure histologique de la mass et de la resorption des travees osseouses
Pathol Biol (Paris)
(1964)
Correlation of bone mineral density with the histological findings of renal osteodystrophy in patients on hemodialysis
J Nephrol
Correlations between bone histopathology and serum biochemistry in uremic patients on chronic hemodialysis
Int J Artif Organs
PICP as bone formation and NTx as bone resorption marker in patients with chronic renal failure
Eur J Med Res
Cited by (0)
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Supported in part by a grant from Novartis.
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Address reprint requests to Rainer Oberbauer, MD, Klinik für Innere Medizin III, Abteilung für Nephrologie und Dialyse, Währinger Gürtel 18-20, A-1090 Vienna, Austria. E-mail: [email protected]
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