The Calcemic Response to Continuous Parathyroid Hormone (PTH)(1-34) Infusion in End-Stage Kidney Disease Varies According to Bone Turnover: A Potential Role for PTH(7-84)

Abstract Context: Factors contributing to PTH resistance in dialysis patients remain elusive. Objectives: The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients. Design: The study was a prospective, controlled assessment of response to PTH(1-34). Setting: The study was performed at the University of California, Los Angeles, General Clinical Research Center. Participants: Nineteen dialysis patients and 17 healthy volunteers were studied. Intervention: PTH(1-34) was infused at a rate of 8 pmol/kg · h for 46 h. Bone biopsy was performed in all dialysis patients. Main Outcome Measures: Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion. Results: Serum calcium levels rose in healthy volunteers (9.2 ± 0.1 to 11.9 ± 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 ± 0.3 to 10.7 ± 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 ± 0.1 to 3.5 ± 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 ± 0.4 to 8.0 ± 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover. Conclusions: The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon.

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Clinical Prediction of High-Turnover Bone Disease After Kidney Transplantation

Calcified Tissue International ◽

10.1007/s00223-021-00917-1 ◽

2021 ◽

Author(s):

Satu M. Keronen ◽

Leena A. L. Martola ◽

Patrik Finne ◽

Inari S. Burton ◽

Xiaoyu F. Tong ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Bone Turnover ◽

Kidney Transplant ◽

Bone Biopsy ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Bone Biomarkers ◽

High Turnover ◽

High Bone Turnover ◽

High Bone

AbstractBone histomorphometric analysis is the most accurate method for the evaluation of bone turnover, but non-invasive tools are also required. We studied whether bone biomarkers can predict high bone turnover determined by bone histomorphometry after kidney transplantation. We retrospectively evaluated the results of bone biopsy specimens obtained from kidney transplant recipients due to the clinical suspicion of high bone turnover between 2000 and 2015. Bone biomarkers were acquired concurrently. Of 813 kidney transplant recipients, 154 (19%) biopsies were taken at a median of 28 (interquartile range, 18–70) months after engraftment. Of 114 patients included in the statistical analysis, 80 (70%) presented with high bone turnover. Normal or low bone turnover was detected in 34 patients (30%). For discriminating high bone turnover from non-high, alkaline phosphatase, parathyroid hormone, and ionized calcium had the areas under the receiver operating characteristic curve (AUCs) of 0.704, 0.661, and 0.619, respectively. The combination of these markers performed better with an AUC of 0.775. The positive predictive value for high turnover at a predicted probability cutoff of 90% was 95% while the negative predictive value was 35%. This study concurs with previous observations that hyperparathyroidism with or without hypercalcemia does not necessarily imply high bone turnover in kidney transplant recipients. The prediction of high bone turnover can be improved by considering alkaline phosphatase levels, as presented in the logistic regression model. If bone biopsy is not readily available, this model may serve as clinically available tool in recognizing high turnover after engraftment.

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Prevalence of Mineral Bone Disease in Dialysis Patients

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd4183 ◽

2021 ◽

Vol 4 (1) ◽

pp. 212-218

Author(s):

Nabiha Rizvi ◽

Faiza Tasleem ◽

Ulfat Altaf

Keyword(s):

Bone Turnover ◽

Complete Blood Count ◽

Albumin Level ◽

Dialysis Patients ◽

Dihydroxyvitamin D ◽

Vitamin D Levels ◽

Low Bone Turnover ◽

High Bone ◽

Stage Renal Disease ◽

End Stage

Progressive loss of kidney function in chronic kidney disease (CKD) leads to reduced production of 1-α-(OH)2-D3 (1,25-dihydroxyvitamin D; calcitriol) and abnormal mineral homeostasis leading to bone mineral disorders. The disorder starts with stage 2 CKD but manifests itself as the disease progresses until stage 3 CKD. Material and methods This study was carried out on 61 patients with end-stage renal disease on regular HD at our Centre. After obtaining informed consent, complete blood count, blood urea level, serum creatinine level, albumin level, uric acid level, Ca level, phosphate level, alkaline phosphatase level, and PTH level were done. Results Out of 60 patients 41 (68.33%) were high bone turnover,10 (16.6%) were normal bone turnover whereas 9(15%) were low bone turnover. Conclusion The prevalence of CKD-MBD among dialysis patients is 83.33% at our center and needs proper monitoring by routine investigations including serum phosphate, calcium, vitamin D levels and most importantly i-PTH levels according to guidelines.

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Diagnostic Accuracy of Biomarkers and Imaging for Bone Turnover in Renal Osteodystrophy

Journal of the American Society of Nephrology ◽

10.1681/asn.2017050584 ◽

2018 ◽

Vol 29 (5) ◽

pp. 1557-1565 ◽

Cited By ~ 27

Author(s):

Syazrah Salam ◽

Orla Gallagher ◽

Fatma Gossiel ◽

Margaret Paggiosi ◽

Arif Khwaja ◽

...

Keyword(s):

Bone Turnover ◽

Diagnostic Accuracy ◽

Renal Osteodystrophy ◽

Bone Biopsy ◽

High Bone Turnover ◽

Biopsy Specimens ◽

Biomarker Analysis ◽

Low Bone Turnover ◽

High Bone

Background Renal osteodystrophy is common in advanced CKD, but characterization of bone turnover status can only be achieved by histomorphometric analysis of bone biopsy specimens (gold standard test). We tested whether bone biomarkers and high-resolution peripheral computed tomography (HR-pQCT) parameters can predict bone turnover status determined by histomorphometry.Methods We obtained fasting blood samples from 69 patients with CKD stages 4–5, including patients on dialysis, and 68 controls for biomarker analysis (intact parathyroid hormone [iPTH], procollagen type 1 N-terminal propeptide [PINP], bone alkaline phosphatase [bALP], collagen type 1 crosslinked C-telopeptide [CTX], and tartrate-resistant acid phosphatase 5b [TRAP5b]) and scanned the distal radius and tibia of participants by HR-pQCT. We used histomorphometry to evaluate bone biopsy specimens from 43 patients with CKD.Results Levels of all biomarkers tested were significantly higher in CKD samples than control samples. For discriminating low bone turnover, bALP, intact PINP, and TRAP5b had an areas under the receiver operating characteristic curve (AUCs) of 0.82, 0.79, and 0.80, respectively, each significantly better than the iPTH AUC of 0.61. Furthermore, radius HR-pQCT total volumetric bone mineral density and cortical bone volume had AUCs of 0.81 and 0.80, respectively. For discriminating high bone turnover, iPTH had an AUC of 0.76, similar to that of all other biomarkers tested.Conclusions The biomarkers bALP, intact PINP, and TRAP5b and radius HR-pQCT parameters can discriminate low from nonlow bone turnover. Despite poor diagnostic accuracy for low bone turnover, iPTH can discriminate high bone turnover with accuracy similar to that of the other biomarkers, including CTX.

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High bone turnover markers and disturbances of bone mineral density in children with hypophosphataemic rickets

Bone Abstracts ◽

10.1530/boneabs.6.p074 ◽

2017 ◽

Author(s):

Agnieszka Rusinska ◽

Izabela Michalus ◽

Izabela Woch ◽

Paulina Adamiecka ◽

Danuta Chlebna-Sokol

Keyword(s):

Bone Mineral Density ◽

Bone Turnover ◽

Bone Mineral ◽

Bone Turnover Markers ◽

Mineral Density ◽

Hypophosphataemic Rickets ◽

High Bone Turnover ◽

High Bone ◽

Turnover Markers

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The Presence of Thyroid-Stimulation Blocking Antibody Prevents High Bone Turnover in Untreated Premenopausal Patients with Graves’ Disease

PLoS ONE ◽

10.1371/journal.pone.0144599 ◽

2015 ◽

Vol 10 (12) ◽

pp. e0144599 ◽

Cited By ~ 10

Author(s):

Sun Wook Cho ◽

Jae Hyun Bae ◽

Gyeong Woon Noh ◽

Ye An Kim ◽

Min Kyong Moon ◽

...

Keyword(s):

Bone Turnover ◽

Graves Disease ◽

Blocking Antibody ◽

High Bone Turnover ◽

High Bone ◽

Premenopausal Patients

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Raloxifene Has No Efficacy in Reducing the High Bone Turnover and the Risk of Spontaneous Vertebral Fractures after Denosumab Discontinuation

Case Reports in Rheumatology ◽

10.1155/2018/5432751 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Elena Gonzalez-Rodriguez ◽

Delphine Stoll ◽

Olivier Lamy

Keyword(s):

Bone Loss ◽

Bone Turnover ◽

Aromatase Inhibitors ◽

Vertebral Fractures ◽

Bone Markers ◽

Rebound Effect ◽

High Bone Turnover ◽

Antiresorptive Agent ◽

High Bone

At denosumab discontinuation, an antiresorptive agent is prescribed to reduce the high bone turnover, the rapid bone loss, and the risk of spontaneous vertebral fractures. We report the case of a woman treated with aromatase inhibitors and denosumab for 5 years. Raloxifene was then prescribed to prevent the rebound effect. Raloxifene was ineffective to reduce the high bone turnover and to avoid spontaneous clinical vertebral fractures. We believe that among the antiresorptive treatments, the most powerful bisphosphonates should be favored, and their administration adapted according to the serial follow-up of bone markers.

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