Bone mineral density and biochemical markers of bone metabolism in predialysis patients with chronic kidney disease

The aim of the study was to evaluate the usefulness of serum bone turnover markers (BTM) and bone mineral density (BMD) determined by dual-energy X-ray absorptiometry (DEXA) in predialysis patients with chronic kidney disease (CKD). We enrolled 83 patients with CKD, 41 (49.4%) males, 42 (50.6%) females, with mean estimated glomerular filtration rate (eGFR) 23.90±12 (range=6.0–56.0). BMD of the lumbar spine (LS) (anteroposterior, L2 through L4), femoral neck (FN) and femoral trochanter (FT) were measured by DEXA. Biochemical BTM, including calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), serum specific alkaline phosphatase (serum AP), bone-specific AP (BSAP), plasma bicarbonate and 25-hydroxy-vitamin D (25hD) were used for the prediction of BMD loss. T score results of LS and FN were worse than FT. BMD levels were lower in females than in males (all p<0.05). According to different BMD T score levels, patients with age ≥65 years and patients in menopause were significantly more osteopenic (p=0.026) and there was no relation between different BMD T scores and presence of diabetes (p=0.654). A positive correlation was identified between the BMD of FN T-Z scores (r=0.270, p=0.029, r=0.306, p=0.012), FT T-Z scores (r=0.220, p=0.076, r:0.250, p=0.043) and serum HCO3, while the correlation with serum alkaline phosphatase (AP) and BSAP was considered to be negative. No statistically significant association was found between BMD of all the measured skeletal sites and eGFR. Loss of BMD was identified mostly in females over ≥65 years of age and after menopause. Higher serum levels of BSAP and AP can be determined in the advanced stages of renal failure and they reflect fracture risk of the femur, but not spine. Measurements of BMD by DEXA are useful to demonstrate bone loss, but not technical enough to distinguish the quantity of bone loss between different stages of CKD.

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Forearm bone mineral density in postmenopausal Indian women: correlation with calcium nutrition

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174196 ◽

2017 ◽

Vol 6 (10) ◽

pp. 4339

Author(s):

Swati Sharma ◽

Bhavna Agarwal ◽

Rohit Sharma ◽

Simarpreet Singh

Keyword(s):

Bone Mineral Density ◽

Alkaline Phosphatase ◽

Bone Mineral ◽

Serum Calcium ◽

Serum Alkaline Phosphatase ◽

Mineral Density ◽

Indian Women ◽

Calcium Nutrition ◽

T Score ◽

Forearm Bone

Background: Osteoporosis is characterized by low bone mass with micro architectural deterioration of bone tissue leading to enhanced bone fragility, thus increasing the susceptibility to fracture. This study was conducted with the objective of measuring forearm bone mineral density in postmenopausal Indian women and to establish a correlation with indices of calcium nutrition i.e. dietary calcium intake, calcium supplements, serum calcium, serum phosphorus, serum alkaline phosphatase and serum intact parathyroid hormone.Methods: Fifty healthy, ambulatory postmenopausal women were selected and a prospective observational study was conducted to correlate the BMD with indices of calcium nutrition. Patient’s laboratory investigations (serum calcium, serum phosphorous, serum alkaline phosphatase and serum intact parathyroid hormone were done and BMD was assessed with dual-energy X-ray absorptiometry at non-dominant forearm; T-scores and Z-score were derived. Correlation analysis was done to investigate the relationship between indices of calcium nutrition and BMD.Results: The proportion of osteoporosis in forearm was 22%in the deficient group, 60% in the insufficient group and 18% in the sufficient group. Among the study group 15 subjects were osteoporotic by T score mid forearm where as 7 were osteoporotic with T score ultra distal forearm and 11 subjects had osteoporosis with T score total forearm.Conclusions: Out of all the indices of calcium nutrition, the correlation between the serum alkaline phosphatase and T score forearm was statistically significant.

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Serum levels of intact parathyroid hormone and alkaline phosphatase correlate with cortical and trabecular bone loss in primary hyperparathyroidism

Acta Endocrinologica ◽

10.1530/acta.0.1270319 ◽

1992 ◽

Vol 127 (4) ◽

pp. 319-323 ◽

Cited By ~ 26

Author(s):

Johannes Pfeilschifter ◽

Elisabeth Siegrist ◽

Christian Wüster ◽

Eberhard Blind ◽

Reinhard Ziegler

Keyword(s):

Bone Mineral Density ◽

Alkaline Phosphatase ◽

Parathyroid Hormone ◽

Bone Loss ◽

Primary Hyperparathyroidism ◽

Bone Mineral ◽

Intact Parathyroid Hormone ◽

Mineral Density ◽

Trabecular Bone Loss ◽

Z Scores

We examined the relationship between bone loss and several biochemical indices in 38 patients with primary hyperparathyroidism. Bone mineral density was reduced by 12±4.0% in the lumbar spine, 18±4.2% at the distal radius and 21±2.8% at the proximal radius (mean±sem). There were significant negative correlations between the serum concentrations of intact parathyroid hormone (PTH) and the Z-scores of the bone mineral content at the proximal and distal radius. In the lumbar spine, bone mineral density was greater in patients with mildly elevated PTH and less in patients whose PTH levels exceeded 8.6 pmol/l. We also observed a strong association between increased levels of serum alkaline phosphatase and low bone mineral Z-scores. Our data thus indicate that cortical and, with the exception of mild primary hyperparathyroidism, trabecular bone loss is proportional to the concentration of circulating PTH and the severity of PTH-induced bone turnover. For the individual patient, however, the usefulness of intact PTH and alkaline phosphatase measurements for assessing bone loss associated with primary hyperparathyroidism seems to be only limited.

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Mineral metabolism, cortical volumetric bone mineral density and fracture risk in childhood chronic kidney disease

Bone Abstracts ◽

10.1530/boneabs.2.oc29 ◽

2013 ◽

Author(s):

Denburg Michelle ◽

Tsampalieros Anne ◽

de Boer Ian ◽

Shults Justine ◽

Kalkwarf Heidi ◽

...

Keyword(s):

Bone Mineral Density ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Fracture Risk ◽

Bone Mineral ◽

Mineral Metabolism ◽

Volumetric Bone Mineral Density ◽

Mineral Density

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RELATION BETWEEN BODY MASS INDEX AND BONE MINERAL DENSITY AMONG HAEMODIALYSIS PATIENTS WITH CHRONIC KIDNEY DISEASE

Journal of Renal Care ◽

10.1111/j.1755-6686.2009.00039.x ◽

2009 ◽

Vol 35 ◽

pp. 57-64 ◽

Cited By ~ 7

Author(s):

Rafael Fernández Castillo ◽

Rafael José Esteban de la Rosa

Keyword(s):

Bone Mineral Density ◽

Body Mass Index ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Body Mass ◽

Bone Mineral ◽

Mineral Density

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Ovarian Failure After Adjuvant Chemotherapy Is Associated With Rapid Bone Loss in Women With Early-Stage Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.14.3306 ◽

2001 ◽

Vol 19 (14) ◽

pp. 3306-3311 ◽

Cited By ~ 308

Author(s):

Charles L. Shapiro ◽

Judith Manola ◽

Meryl Leboff

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Alkaline Phosphatase ◽

Adjuvant Chemotherapy ◽

Bone Loss ◽

Bone Mineral ◽

Ovarian Failure ◽

Mineral Density ◽

Specific Alkaline Phosphatase ◽

Bone Specific Alkaline Phosphatase

PURPOSE: We sought to evaluate the effects of chemotherapy-induced ovarian failure on bone loss and markers of skeletal turnover in a prospective longitudinal study of young women with breast cancer receiving adjuvant chemotherapy. PATIENTS AND METHODS: Forty-nine premenopausal women with stage I/II breast cancers receiving adjuvant chemotherapy were evaluated within 4 weeks of starting chemotherapy (baseline), and 6 and 12 months after starting chemotherapy with dual-energy absorptiometry and markers of skeletal turnover osteocalcin and bone-specific alkaline phosphatase. Chemotherapy-induced ovarian failure was defined as a negative pregnancy test, greater than 3 months of amenorrhea, and a follicle-stimulating hormone ≥ 30 MIU/mL at the 12-month evaluation. RESULTS: Among the 35 women who were defined as having ovarian failure, highly significant bone loss was observed in the lumbar spine by 6 months and increased further at 12 months. The median percentage decrease of bone mineral density in the spine from 0 to 6 months and 6 to 12 months was −4.0 (range, −10.4 to +1.0; P = .0001) and −3.7 (range, −10.1 to 9.2; P = .0001), respectively. In contrast, there were no significant decreases in bone mineral density in the 14 patients who retained ovarian function. Serum osteocalcin and bone specific alkaline phosphatase, markers of skeletal turnover, increased significantly in the women who developed ovarian failure. CONCLUSION: Chemotherapy-induced ovarian failure causes rapid and highly significant bone loss in the spine. This may have implications for long-term breast cancer survivors who may be at higher risk for osteopenia, and subsequently osteoporosis. Women with breast cancer who develop chemotherapy-induced ovarian failure should have their bone density monitored and treatments to attenuate bone loss should be evaluated.

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