The pitfall of treating low bone turnover: Effects on cortical porosity |
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| Institution: | 1. Nephrology Division, Universidade de São Paulo, São Paulo, Brazil;2. Nephrology Division, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil;3. Nephrology Division, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil;4. Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil;5. Medicine Master Degree Program, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil;6. Nephrology Division, Universidade Federal do Paraná, Curitiba, Brazil;1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States;2. Beck Radiological Innovations, Inc., United States;3. Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD, United States;4. Novartis Institute for Biomedical Research, United States;5. Department of Epidemiology and Public Health, University of Maryland, School of Medicine, United States;6. National Institute on Aging, Longitudinal Study Section, United States;7. Department of Sociology and Anthropology, University of Maryland Baltimore County, United States;8. University of Maryland, School of Medicine, United States;9. Research Institute, California Pacific Medical Center, San Francisco, CA, United States;10. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States;11. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, United States;12. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States;13. Laboratory of Epidemiology and Population Sciences Intramural Research Program, National Institute on Aging, United States;1. Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Box 0560, San Francisco, CA 94158-2549, USA;2. Eli Lilly Regional Operations, Koelblgasse 8-10 A-1030, Wien, Austria;3. Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA |
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| Abstract: | Although it is recognized that cortical bone contributes significantly to the mechanical strength of the skeleton, little is known about this compartment from bone biopsy studies, particularly in CKD patients. In addition, there is no prospective data on the effects of CKD-MBD therapy on cortical porosity (Ct.Po). This is a post hoc analysis on data from a randomized controlled trial on the effects of different phosphate binders on bone remodelling. Therapy was adjusted according to the first biopsy, and included sevelamer or calcium acetate, calcitriol and changes in calcium dialysate concentration. We measured Ct.Po at baseline and one year after. Fifty-two patients (46 ± 13 years old, 67% women and 60% white) were enrolled. Ct.Po was already high at baseline in 85% of patients 30% (17, 46)] and correlated with PTH (p = 0.001). Low bone turnover was seen in 28 patients (54.9%). After one-year treatment, PTH increased in patients with low turnover, as intended. However, increased Ct.Po was seen in 49 patients (94%). This increase correlated with the delta of phosphate (p = 0.015) and the delta of PTH (p = 0.03); it was also higher among non-white patients than in white patients (p = 0.039). The risk of increase in Ct.Po was 4.5 higher among non-white patients. Adjusted multiple regression analysis showed that the delta of Ct.Po was dependent on delta PTH and race (r2 = 0.193). We concluded that in an attempt to increase bone turnover, the increase in PTH levels might be associated with higher cortical porosity, particularly in non-white patients. Whether this finding leads to a high risk of fracture deserves further investigation. |
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