Osteoporosis in hemodialysis patients revisited by bone histomorphometry: A new insight into an old problem

Osteoporosis in hemodialysis patients revisited by bone histomorphometry: A new insight into an old problem

Author Barreto, Fellype Carvalho Autor UNIFESP Google Scholar
Barreto, Daniela Veit Google Scholar
Moysés, Rosa Maria Affonso Google Scholar
Neves, C. L. Google Scholar
Jorgetti, Vanda Google Scholar
Draibe, Sergio Antonio Autor UNIFESP Google Scholar
Canziani, Maria Eugenia Autor UNIFESP Google Scholar
Carvalho, A. B. Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Abstract Osteoporosis in hemodialysis patients is associated with high morbidity and mortality and, although extensively studied by noninvasive methods, has never been assessed through bone biopsy. the aim of this study was to use histomorphometry to evaluate osteoporosis and identify factors related to its development in hemodialysis patients. We conducted a cross-sectional study involving 98 patients ( 35 women and 63 men; mean age: 48.4 +/- 13 years) on hemodialysis for 36.9 +/- 24.7 months. Patients were submitted to transiliac bone biopsy with double tetracycline labeling. the bone metabolism factors ionized calcium, phosphorus, bone alkaline phosphatase, deoxypyridinoline, intact parathyroid hormone, and 25( OH) vitamin D were evaluated, as were the bone remodeling cytokines osteoprotegerin (OPG), soluble receptor-activator of NF-kappa beta ligand (sRANKL) and tumor necrosis factor-alpha (TNF)alpha. Osteoporosis was defined as trabecular bone volume ( BV/ TV) greater than 1 s.d. below normal ( men < 17.4%; women < 14.7%). Forty-five patients (46%) presented osteoporosis, which was correlated with white race. We found BV/ TV to correlate with age, OPG/sRANKL ratio, TNF alpha levels, and length of amenorrhea. in multiple regression analysis adjusted for sex and age, length of amenorrhea, white race, and OPG/ sRANKL ratio were independent determinants of BV/TV. Histomorphometric analysis demonstrated that osteoporotic patients presented normal eroded surface and low bone formation rate (BFR/BS). Osteoporosis is prevalent in hemodialysis patients. Low BFR/BS could be involved in its development, even when bone resorption is normal. Cytokines may also play a role as may traditional risk factors such as advanced age, hypogonadism, and white race.
Keywords bone diseases
metabolic
osteoporosis
dialysis
bone histomorphometry
Language English
Date 2006-05-01
Published in Kidney International. New York: Nature Publishing Group, v. 69, n. 10, p. 1852-1857, 2006.
ISSN 0085-2538 (Sherpa/Romeo, impact factor)
Publisher Nature Publishing Group
Extent 1852-1857
Origin http://dx.doi.org/10.1038/sj.ki.5000311
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000237673800030
URI http://repositorio.unifesp.br/handle/11600/28855

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