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Bone mineral density (Z-score) in the lumbar spine, femoral neck and forearm in patients on haemodialysis (HD) or peritoneal dialysis (PD). Data are shown as median, interquartiles and range. Grey bars are HD patients, striped bars are PD patients, while white bars are all dialysis patients.
Source publication
The aim of the study was to identify biomarkers of alteration in bone mineral density (BMD) in patients on haemodialysis (HD) and peritoneal dialysis (PD).
In a cross-sectional, longitudinal study dual-energy X-ray absorptiometry scans were performed in 146 HD-patients and 28 PD-patients. Follow-up after 14 months (mean) was conducted in 73 patient...
Context in source publication
Citations
... Nevertheless, osteoporotic individuals exhibited higher alkaline phosphatase levels, a marker indicating bone turnover, consistent with findings from previous research [39,40]. However, although this observation reached statistical significance, it is essential to clarify that the slight difference in median alkaline phosphatase levels between osteoporotic and non-osteoporotic groups may not be clinically significant. ...
Background
End-stage renal disease (ESRD) patients often experience accelerated bone turnover, leading to osteoporosis and osteopenia. This study aimed to determine the prevalence of osteoporosis in Peritoneal Dialysis (PD) patients using bone mineral density (BMD) measurements obtained through dual-energy X-ray absorptiometry (DEXA) scan and to explore any possible associations with clinical and biochemical factors.
Methods
In this cross-sectional study, we enrolled 76 peritoneal dialysis patients from the dialysis center at An-Najah National University Hospital in Nablus, Palestine. We used the DEXA scan to measure BMD at the lumbar spine and hip, with values expressed as T-scores. We conducted a multivariate analysis to explore the relationship between BMD and clinical and biochemical parameters.
Results
Over half (52.6%) of the PD patients had osteoporosis, with a higher prevalence observed among patients with lower BMI (p<0.001). Higher alkaline phosphatase levels were found among osteoporotic patients compared to non-osteoporotic patients (p = 0.045). Vitamin D deficiency was also prevalent in this population, affecting 86.6% of patients. No significant correlation was found between 25 vitamin D levels and BMD. No significant correlation was found between Parathyroid hormone (PTH) levels and BMD.
Conclusion
A notable proportion of PD patients experience reduced BMD. Our study found no correlation between vitamin D levels and BMD, but it highlighted the significant vitamin D deficiency in this population. Furthermore, our analysis indicated a positive correlation between BMI and BMD, especially in the femoral neck area. This underscores the significance of addressing bone health in PD patients to mitigate the risk of fractures and improve their overall well-being.
... In harmony with current work, Nybo et al. reported that, BMD correlated with levels of iPTH and ALP [23]. ...
Aims: To evaluate the carboxy-terminal telopeptide of type I collagen (CTX I) as a serum bone metabolism marker in hemodialysis patients. Study Design: Cross-sectional observational. Place and Duration of Study: Hemodialysis unit of Tanta University Hospital, between October 2018 and March 2020. Methodology: 80 male patients aged from (18-65y) on regular hemodialysis were included. All patients were subjected to: history taking, full clinical examination, laboratory investigations including: Serum calcium, serum phosphorus, serum albumin, alkaline phosphatase (ALP), Intact parathyroid hormone (iPTH), serum carboxy-terminal cross linking telopeptide (CTX I) and dual energy X ray absorptiometry (DEXA) scan of the lower third of the right fibula to evaluate bone mineral density (BMD) and patient were divided according to bone mineral density T score into two groups "normal and osteopenic groups". Results: There is significant difference between normal and osteopenic groups according to iPTH (p = 0.001) and ALP (p = 0.001) and CTX I (p = 0.001), but there is non-significant difference between normal and osteopenic groups according to serum calcium (p =0.239), serum phosphorus (p =0.672), serum albumin (p =0.749) and corrected serum calcium (p = 0.314).There was negative significant correlation between CTX I and DEXA scan, and between DEXA scan and iPTH and ALP. There was positive significant correlation between CTX I and iPTH, ALP and serum albumin and there was positive significant correlation between iPTH and ALP. At cutoff 2.0 ng/ml CTX I can significantly diagnose osteopenia in hemodialysis patients with 93% sensitivity, 95% specificity and accuracy of 92%. It had positive predictive value of 95% and negative predictive value of 83%, in multiple regression analysis the increase in iPTH and CTX I was the significant predictor of osteopenia. Conclusion: This study showed high association between CTX I and other established markers of bone metabolism and BMD by DEXA demonstrating the potential utility of CTX I as marker of bone resorption in renal bone disease.
... Several studies are consistent with our study showing that BMD decreased as age increased [14,17,18]. The effect of gender on bone mass in hemodialysis is controversial [19,20]. We found that BMD was significantly lower in women at the total body. ...
Background:
Bone disease is common in patients undergoing hemodialysis. It is the result of bone turnover abnormalities and the decrease of bone mineral density (BMD). We aimed to determine the usefulness of serum bone turnover markers and BMD measurement by dual-energy x-ray absorptiometry (DXA) in hemodialysis patients.
Methods:
We conducted a cross-sectional study including 90 hemodialysis for more than 12 months. Bone mineral density was assessed by DXA. Peripheral blood samples were obtained from each patient before dialysis in a fasting state within a week of the DXA. Biochemical variables of calcium and phosphate were measured. One bone formation marker (bone-specific alkaline phosphatase (bAP), one bone resorption marker (carboxy-terminal telopeptides of type 1 collagen (CTX)) were measured. Total alkaline phosphatase (TAP), intact parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) which is a bone-derived hormone were also measured.
Results:
CTX values were 6.25 times higher than the normal limit of the assay. Bone alkaline phosphatase levels were less than 10 ng/mL in 28.8% of cases. 23% of patients have osteoporosis and 45% have osteopenia. Femoral BMD had negative correlations with age and PTH levels. FGF23 levels were significantly increased in patients with osteoporosis affecting the lumbar. The levels of bAP and CTX showed a positive correlation. Both circulating bAP and CTX levels showed also positive correlations with PTH levels. Fractures, observed in 12.2% of cases, were associated with low PTH values and the existence of osteoporosis.
Conclusions:
Our study showed that osteoporosis and fracture are common in dialysis patients. The reduced BMD was associated with advanced age and elevated levels of PTH. Markers of bone turnover and FGF23 may play a role in the diagnosis of bone disease in hemodialysis patients. DXA measurement is necessary for the monitoring for bone loss.
... This study showed no significant difference in BMD between patients on HD and PD (p = 0.571), which is in line with the findings of Nybo M et al. [25]. Higher PTH level is an indicator of lower BMD as patients with lower total BMD have higher serum levels of PTH, 792.9 pg/mL among osteoporotic patients compared with 469 pg/mL and 454 pg/mL among osteopenic and normal patient, respectively. ...
... Even though no significant association was found between BMD and history of renal transplantation according to LS or hip (P = 0.059, P = 0.718 respectively), the relationship between bone loss and long term use of immunosuppressive agents in transplant patients requires further study. In a another study, patients who had received glucocorticoids had lower BMD Z-score in both femoral neck and spine compared with patients who had received no such treatment [25]. These patients should thus be considered candidates for a closer continuous monitoring. ...
Introduction
End-Stage Renal Disease (ESRD) is the ultimate result of chronic kidney disease (CKD). In Palestine, the prevalence of ESRD was 240.3 PMP which is comparable with the nearby countries. Accelerated bone loss among ESRD patients is attributed to abnormal bone turn over that leads to osteoporosis and osteopenia. The risk of fractures is increased four-fold in men and women on hemodialysis, which explains the importance of assessing the bone mineral density among these population. The goals of this study were to find the prevalence of osteoporosis in ESRD patients as determined by bone mineral density (BMD) at different sites and to determine whether BMD correlates with many other clinical parameters.
Methods
A cross-sectional study of 194 ESRD patients were recruited from the dialysis unit in An-Najah National University Hospital, Nablus, Palestine. The patients were on regular hemodialysis or peritoneal dialysis. BMD was measured at the lumbar spine and the hip using the dual-energy X-Ray absorptiometry (DEXA) and the value is expressed as T-score. The data were analyzed using SPSS, version 26. The relationship between BMD and the clinical and biochemical parameters among the ESRD patients was assessed.
Results
We found that 42.8% of ESRD patient had osteoporosis and 40.2% had osteopenia. There were significantly higher proportions of osteoporosis and osteopenia among patients >60 years of age (p<0.005). Patients with osteoporosis and osteopenia had significantly higher serum levels of PTH (792.9 and 469.7) (p<0.05). BMD decreases as the duration of dialysis (39.0 months Vs. 56.8 months), (p<0.05). We found no significant difference between patients on hemodialysis or peritoneal dialysis.
Conclusion
This study showed that Palestinian patients with ESRD have low BMD at the hip and spine. The observed high serum level of PTH was associated with low BMD. Those patients should be closely monitored especially those with more than one risk factor. Moreover, more attention should be paid for these category of patients to decrease the incidence of falling down and the resulting fractures that might lead to mortality and morbidity.
... Each dialysis modality causes physiological changes that may affect the bone and mineral metabolism differently. 11,12 The choice of renal replacement therapy usually depends on several important factors. However, it is also crucial to evaluate if the dialysis modality differs about hip fracture risk. ...
Background
Bone and mineral metabolism disorders are common among end‐stage renal disease (ESRD) patients, which could lead to hip fracture. It is unclear whether the hip fracture risk is different among patients on hemodialysis (HD) versus peritoneal dialysis (PD). This meta‐analysis was conducted to evaluate the hip fracture risk in ESRD patients on HD, when compared to PD.
Methods
A literature review was conducted in EMBASE, MEDLINE, and Cochrane databases through January 31, 2018 to identify studies that appraised the rate or risk of hip fracture among patients on HD, when compared to PD. Effect estimates from the individual studies were derived and consolidated utilizing random‐effect, generic inverse variance approach of DerSimonian and Laird.
Results
Five cohort studies with 1 276 677 ESRD patients were enrolled. HD status was associated with a significantly higher risk of hip fracture with the pooled odds ratio (OR) of 1.61 (95% confidence interval [CI] 1.50‐1.73, I² = 10.0%), compared with PD. When the analysis was limited to studies with confounder‐adjusted analysis, the pooled OR of hip fracture among HD patients was 1.57 (95% CI 1.43‐1.72, I² = 13.6%). Funnel plots and Egger's regression test demonstrated no significant publication bias in our meta‐analysis.
Conclusions
Among ESRD patients, HD status is associated with a 61% higher risk of hip fracture compared to PD.
... Fractures occur more frequently in dialysis patients compared to general population [15,16] and the BMD of the dialysis patients is significantly lower compared to healthy controls [16]. No differences were found in BMD between hemodialysis and peritoneal dialysis [17]. Low BMD also represents an independent mortality risk factor [18]. ...
Background/aims:
Small attention is paid to other types of bone diseases then chronic kidney disease-mineral and bone disorder in dialysis patients. The aim of our study was to assess the occurrence of osteoporosis and bone microarchitecture by trabecular bone score in this population.
Methods:
59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafIltration underwent densitometry (Lunar Prodigy, TBS software 2.1.2) and laboratory assessment.
Results:
Osteoporosis was observed in 34% patients, high bone turnover was found in 80% of them, with SHPT (PTH > 300 ng/l) present in 69%. TBS was significantly decreased in 47.5% of the patients. TBS correlated with T- and Z-scores of the lumbar spine and proximal femur in the total population (P < 0.0001) and in men (P < 0.00001) and there were significant differences between TBS in groups with normal densitometry, osteopenia, and osteoporosis, both in total population (P < 0.0001; P < 0.01) and in men (P < 0.001; P < 0.001).
Conclusions:
Osteoporosis was found in about 1/3 of patients treated with hemodiafiltration. Normal TBS was found in only 1/4 of the dialysis population. TBS correlated with densitometric parameters and was significantly different relative to T-scores.
... Des troubles du métabolisme osseux et des altérations de la DMO surviennent dès que le la clairance diminue en dessous de 60 ml/min (52). Alem retrouvait un risque relatif de fracture de hanche supérieur à 4 chez les patients insuffisants rénaux terminaux dialysés (53). Une étude danoise retrouvait que la perte de la DMO était corrélée avec la durée de la dialyse. ...
Introduction : L’ostéoporose chez les transplantés rénaux est complexe et multifactorielle. Nous avons étudié l’évolution du Trabecular Bone Score (TBS) et de la densité minérale osseuse (DMO) chez les patients transplantés rénaux ainsi que les facteurs concourant à leurs variations. Méthode : Les patients greffés au CHU de Rouen entre aout 2008 et janvier 2013 ont été sélectionnés. Ils devaient avoir bénéficié de deux examens de densitométrie osseuse mesurée par absportiométrie biphotonique à rayons X (DEXA). Le TBS était calculé rétrospectivement. Résultats : 66 patients ont été inclus. La variation du TBS n’est pas significative entre les deux visites. Le gain de DMO est significatif aux trois sites, rachis lombaire +3,3%, hanche totale + 3,7%, col fémoral +2,2% (p<0,01). La durée de la corticothérapie est négativement corrélée avec le TBS (r = - 0,41) et la DMO au rachis lombaire (r = -0,52) (p<0,0001). Une hyperparathyroïdie ou un diabète cortico ou chimio induit sont associés à une moins bonne évolution du TBS (-0,046 IC 95% -0.074; 0.016] versus +0,031 IC 95% [-0.002; 0.059], p=0,02 et -0,048 IC95% [-0.075; 0.017] versus 0,038 IC 95% [-0.016; 0.065], p<0,01) alors que les résultats concernant la DMO ne sont pas significatifs. Concernant la prise de bisphosphonates, on retrouve une corrélation positive avec la DMO à la hanche totale (r = 0,33, p=0,02). Conclusion : Le TBS apporte des informations complémentaires à la DMO dans l’évaluation du risque ostéoporotique chez les patients greffés, notamment en rapport avec la corticothérapie, l’hyperparathyroïdie ou le diabète.
... It was reported that ADAMTS-18 was a bone mass candidate gene in different ethnic groups (30, 76). Bone mineral density (BMD) was a prominent osteoporosis risk factor (79)(80)(81). Masses of single nucleotide polymorphisms (SNPs) were genotyped in different ethnic groups indicating that both ADAMTS-18 and TGFBR3 were BMD candidate genes (30). In addition, Meta-analyses supported the significant associations of ADAMTS-18 and TGFBR3 with BMD (30). ...
ADAMTS-18 is a member of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) family of proteases, which are known to play important roles in development, angiogenesis and coagulation; dysregulation and mutation of these enzymes have been implicated in many disease processes, such as inflammation, cancer, arthritis and atherosclerosis. Mutations of ADAMTS-18 have been linked to abnormal early eye development and reduced bone mineral density. In this review, we briefly summarize the structural organization and the expression of ADAMTS-18. We will also focus on the emerging role of ADAMTS-18 in several pathophysiological conditions which include: hematological diseases, tumorgenesis, osteogenesis, eye-related diseases, central nervous system disorders, and last but not least a research perspective of ADAMTS-18 and its potential as a promising diagnostic and therapeutic target.
Bone mineral density in Palestinian patients with end-stage renal disease and the related clinical and biochemical factors: Cross-se… Abstract Introduction
The article is devoted to the problem of treatment of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) on renal replacement therapy with programmed hemodialysis. The pathogenesis of VHPT is based on vitamin D deficiency and the associated launch of a cascade of complications of mineral metabolism, which subsequently leads to significant changes in the morphology and density of bone tissue, as well as cardiovascular complications. According to the main clinical guidelines, the goals of treating IHPT in patients with CKD are aimed at preventing the progression of the disease and suppressing the activity of the parathyroid glands by modulating vitamin D receptors and calcium-sensitive receptors. Maintaining the level of parathyroid hormone within the target values improves the quality of life of patients, reduces the incidence of cardiovascular and bone complications. The article presents the result of our own clinical observation on the correction of alfacalcidol-resistant IHPT with hypercalcemia and hyperphosphatemia in a patient on programmed hemodialysis using a combination therapy with a calcimimetic – cinacalcet, colecalciferol and a selective activator of vitamin D receptors – paricalcitol. On the example of a clinical case, the compensation of IHPT, an improvement in the condition of the altered parathyroid glands, bone tissue without the risk of developing hypo-, hypercalcemia and hyperphosphatemia during long-term treatment was demonstrated.
