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Bone turnover markers are associated with bone density, but not with fracture in end stage kidney disease: a cross-sectional study.

ABSTRACT: Fracture risk is increased in chronic kidney disease (CKD), but assessment of bone fragility remains controversial in these patients. This study investigated the associations between bone turnover markers, bone mineral density (BMD), and prevalent fragility fracture in a cohort of kidney transplantation candidates.Volumetric BMD of spine and hip was measured by quantitative computed tomography. Parathyroid hormone (PTH), bone-specific alkaline phosphatase, procollagen type-1 N-terminal propeptide, tartrate resistant alkaline phosphatase, and C- and N-terminal telopeptides of type 1 collagen were analyzed from fasting morning blood samples. Fragility fractures included prevalent vertebral fractures and previous low-trauma clinical fractures.The fracture prevalence was 18% in 157 adult kidney transplant candidates. Fractured patients had reduced BMD and Z-score at both spine and hip. Levels of bone turnover markers were significantly higher in patients on maintenance dialysis than in pre-dialysis patients; but did not differ between patients with and without fracture. There were strong, positive correlations between PTH and all bone turnover markers. PTH was negatively associated with Z-score at lumbar spine and total hip; in contrast, bone turnover markers were only negatively associated with total hip Z-score.Bone turnover markers were negatively associated with bone density, but not associated with prevalent fracture in kidney transplantation candidates. The role of bone turnover markers in assessing bone fragility in CKD will require further investigation.This study was registered at ClinicalTrials.gov with identifier NCT01344434 .

SUBMITTER: Jorgensen HS

PROVIDER: S-EPMC5586067 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Bone turnover markers are associated with bone density, but not with fracture in end stage kidney disease: a cross-sectional study.

Jørgensen Hanne Skou HS Winther Simon S Bøttcher Morten M Hauge Ellen-Margrethe EM Rejnmark Lars L Svensson My M Ivarsen Per P

BMC nephrology 20170906 1

<h4>Background</h4>Fracture risk is increased in chronic kidney disease (CKD), but assessment of bone fragility remains controversial in these patients. This study investigated the associations between bone turnover markers, bone mineral density (BMD), and prevalent fragility fracture in a cohort of kidney transplantation candidates.<h4>Methods</h4>Volumetric BMD of spine and hip was measured by quantitative computed tomography. Parathyroid hormone (PTH), bone-specific alkaline phosphatase, proc ...[more]

PMID: 28874132

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Project description:BackgroundKidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients.Patients-methodPatients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD.ResultsOne hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024-1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015-0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX.ConclusionExploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.

Project description:ObjectiveUndercarboxylated osteocalcin (ucOC) is one form of osteocalcin lacking full carboxylation, which plays an important role in bone homeostasis, glucose homeostasis, and energy metabolism. Our aim is to obtain the profile of serum ucOC level according to gender and age and explore its associations with bone mineral density (BMD), bone turnover markers (BTMs), and prevalence of osteopenia and osteoporosis in the Chinese population.MethodsThis is a cross-sectional study with 900 subjects, composed of 431 men and 469 women. Clinical information was collected, and BMD values of the lumbar spine (L1-4), left femoral neck, and total hip were scanned. Biochemical markers including hepatic and renal function, serum calcium, serum phosphorus, procollagen type 1 N-propeptide (P1NP) β-CrossLaps of type I collagen-containing cross-linked C-telopeptide (β-CTX) intact parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ucOC were measured.ResultsWe found that the median ucOC level was higher in men than women [men, 2.6 ng/ml; women, 1.6 ng/ml; p < 0.001]. The profile according to age showed that ucOC levels were the lowest at the age of 40-49 years in both men [2.55 ng/ml (95% CI = 1.96-3.13 ng/ml)] and women [1.57 ng/ml (95% CI = 1.12-2.03 ng/ml)]; in patients younger than 49 years, they decreased with age; then over 50 years, they quickly increased. Furthermore, we found that a higher ucOC level was correlated with lower BMD values at the lumbar spine (men, r = -0.128, p = 0.013; women, r = -0.321, p < 0.001), femoral neck (men, r = -0.095, p = 0.062; women, r = -0.260, p < 0.001), and total hip (men, r = -0.123, p = 0.015; women, r = -0.209, p < 0.001) and higher P1NP (men, r = 0.307, p < 0.001; women, r = 0.239, p < 0.001) and β-CTX (men, r = 0.169, p = 0.001; women, r = 0.354, p < 0.001) levels in both men and women. Furthermore, we also showed that a 1 - SD increase in ucOC was associated with an odds ratio (OR) of 1.63 and 1.70 for having osteopenia or osteoporosis in men and women, respectively (men, 95% CI = 1.25-2.13, p = 0.004; women, 95% CI = 1.19-2.42, p = 0.004).ConclusionsWe first revealed the profile of serum ucOC levels according to gender and age in the Chinese population and demonstrated the associations of ucOC with BMD and BTMs and the risk of prevalent osteopenia or osteoporosis. Our findings provide a clue to elucidate the function of ucOC in bone metabolism.

Project description:IntroductionEnd-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.MethodsA 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.ResultsWe 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.ConclusionThis 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.

Project description:Purpose: The association between bone mineral density (BMD), bone turnover markers, and serum cholesterol in healthy population has already been proved. However, in patients with type 2 diabetes mellitus (T2D), it has not been adequately analyzed. In this study, we investigated the correlation between BMD, bone turnover markers, and serum cholesterol levels in people with T2D. Methods: We enrolled 1,040 men and 735 women with T2D from Zhongshan Hospital between October 2009 and January 2013. Their general condition, history of diseases and medication, serum markers, and BMD data were collected. We used logistic regression analysis to identify the association between serum cholesterol levels and BMD as well as bone turnover markers. Results: In multivariate regression analysis, we observed that in men with T2D, high high-density lipoprotein-cholesterol and total cholesterol levels were significantly associated with low total lumbar, femur neck, and total hip BMD, while low-density lipoprotein-cholesterol level was only inversely associated with total lumbar and femur neck BMD. Total cholesterol and low-density lipoprotein-cholesterol levels were also negatively associated with osteocalcin, procollagen type I N-terminal propeptide, and ?-crosslaps. In women with T2D, high-density lipoprotein-cholesterol level was observed to be negatively correlated with total lumbar, femur neck, and total hip BMD, while total cholesterol and low-density lipoprotein-cholesterol levels were only associated with BMD at the total lumbar. Furthermore, total cholesterol was also negatively associated with osteocalcin, procollagen type I N-terminal propeptide, and ?-crosslaps; high-density lipoprotein-cholesterol was only related to osteocalcin and parathyroid hormone, while low-density lipoprotein-cholesterol was only related to ?-crosslaps in women. Conclusion: Our study suggests a significantly negative correlation between serum cholesterol levels and BMD in both men and women with T2D. The associations between serum cholesterol levels and bone turnover markers were also observed in T2D patients.

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Bone turnover markers are associated with bone density, but not with fracture in end stage kidney disease: a cross-sectional study.

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Bone turnover markers are associated with bone density, but not with fracture in end stage kidney disease: a cross-sectional study.

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