Abstract
BackgroundBone 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.MethodsWe 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.ResultsCTX 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.ConclusionsOur 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.
Highlights
Bone disease is common in patients undergoing hemodialysis
The duration of hemodialysis was less than 5 years in 61% of patients whereas it was more than 10 years in only two cases
Bone alkaline phosphatase levels were less than 10 ng/mL in 26 cases and higher than 25 ng/mL in 31 cases
Summary
Bone disease is common in patients undergoing hemodialysis. It is the result of bone turnover abnormalities and the decrease of bone mineral density (BMD). Bone disease is highly prevalent in patients with chronic kidney disease on dialysis (CKD-5D) [1]. It can induce serious bone health problems, especially fragility fractures. Bone disease in patients with CKD-5D is the result of bone turnover abnormalities and the decrease of bone mineral density (BMD). Bone biopsy remains the gold standard for the diagnosis of bone turnover abnormalities It is an invasive method and repetitive assessment of bone status cannot be possible. Multiple factors are associated with reduced BMD and may affect bone health [3]
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