Comparison of laboratory and imaging methods associated with bone metabolism in patients with or without renal failure under the age of 45 years with elevated parathyroid hormone levels

Yıl 2019, Cilt: 5 Sayı: 3, 515 - 521, 04.05.2019

Hande Peynirci Canan Ersoy Vildan Gürsoy Ayten Girgin Mehmet Ali Aşık Ahmet Gültepe Güven Özkaya Emel Isıktas Sayılar Alpaslan Ersoy

https://doi.org/10.18621/eurj.378720

Öz

Objectives: Although bone biopsy is
considered the gold standard for the definitive diagnosis of renal
osteodystrophy; it is not suitable for routine clinical practice due to its
invasive nature. The present
study was aimed to evaluate and compare the
bone mineral status using dual energy
X-ray absorptiometry of patients with
or without chronic kidney disease in young population with elevated parathyroid hormone
levels.

Methods: This was a single center, cross-sectional,
retrospective study conducted in patients younger than 45 years of age. The study was performed in the outpatient clinic of a
university hospital. Patients
with elevated parathyroid hormone levels were included.

Results: Among them, 29 had renal insufficiency, 158 had normal
renal function. Measured bone mineral
density with dual energy X-ray absorptiometry
and laboratory values were collected from patient files. The primary end point was to assess the efficiacy of dual
energy X-ray absorptiometry in patients with or without renal failure. Except
Z score at Ward’s triangle, all of the T and Z scores at lomber, femur neck, trochanteric, and
intertrochanteric areas were found significantly lower in
patients with chronic kidney disease compared to those without
(p < 0.001).

Conclusion: Dual energy X-ray absorptiometry seemed to be a
reliable method for detection of osteoporosis in premenopausal female and male
patients younger than 45 years of age with or without renal
failure with elevated parathyroid hormone levels. 

Anahtar Kelimeler

hyperparathyroidism, renal insufficiency, osteoporosis, dual energy X-ray absorptiometry

Kaynakça

• [1] Eknoyan G, Lameire N, Barsoum R, Eckardt KU, Levin A, Levin N, et al. The burden of kidney disease: improving global outcomes. Kidney Int 2004;66:1310-4.
• [2] Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, et al. Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med 2018;168:422-30.
• [3] Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995;17(5 Suppl):S505-11.
• [4] Malluche HH, Mawad HW, Monier-Faugere MC. Renal osteodystrophy in the first decade of the new millennium: analysis of 630 bone biopsies in black and white patients. J Bone Miner Res 2011;26:1368-76.
• [5] Miller PD. The role of bone biopsy in patients with chronic renal failure. Clin J Am Soc Nephrol 2008;3 Suppl 3:S140-50.
• [6] Fontaine MA, Albert A, Dubois B, Saint-Remy A, Rorive G. Fracture and bone mineral density in hemodialysis patients. Clin Nephrol 2000;54:218-26.
• [7] Khan MI, Syed GM, Khan AI, Sirwal IA, Anwar SK, Al-Oufi AR, et al. Mean bone mineral density and frequency of occurrence of osteopenia and osteoporosis in patients on hemodialysis: a single-center study. Saudi J Kidney Dis Transpl 2014;25:38-43.
• [8] Jannot M, Mac-Way F, Lapierre V, Lafage-Proust MH. The use of bone mineral density measured by dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed microtomography in chronic kidney disease. J Nephrol 2017;30:635-43.
• [9] Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet 2011;377:1276-87.
• [10] NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001;285:785-95.
• [11] O'Connor KM. Evaluation and treatment of osteoporosis. Med Clin North Am 2016;100:807-26.
• [12] Lima GA, Paranhos Neto Fde P, Pereira GR, Gomes CP, Farias ML. Osteoporosis management in patient with renal function impairment. Arq Bras Endocrinol Metabol 2014;58:530-9.
• [13] Ford ML, Smith ER, Tomlinson LA, Chatterjee PK, Rajkumar C, Holt SG. FGF-23 and osteoprotegerin are independently associated with myocardial damage in chronic kidney disease stages 3 and 4. Another link between chronic kidney disease-mineral bone disorder and the heart. Nephrol Dial Transplant 2012;27:727-33.
• [14] Kovesdy CY, Anderson JE, Kalantar-Zadeh K. Association of serum bicarbonate levels with mortality in patients with non-dialysis-dependent CKD. Nephrol Dial Transplant 2009;24:1232-7.
• [15] Tolouian R, Hernandez GT, Chiang WY, Gupta A. A new approach for evaluating bone turnover in chronic kidney disease. Eur J Intern Med 2010;21:230-2.
• [16] Nickolas TL, Leonard MB, Shane E. Chronic kidney disease and bone fracture: a growing concern. Kidney Int 2008;74:721-31.
• [17] Seeman E. Clinical review 137: sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab 2001;86: 4576-84.
• [18] Centers for Disease Control and Prevention (CDC). Prevalence of chronic kidney disease and associated risk factors--United States, 1999-2004. MMWR Morb Mortal Wkly Rep 2007;56:161-5.
• [19] Nadim MK, Dua R, Campese VM. Antihypertensive drugs and the kidney. Curr Cardiol Rep 2004;6:403-8.
• [20] Jean G, Souberbielle JC, Chazot C. Vitamin D in chronic kidney disease and dialysis patients. Nutrients 2017;9(4). pii: E328.
• [21] Satman I, Ozbey N, Boztepe H, Kalaca S, Omer B, Tanakol R, et al. Prevalence and correlates of vitamin D deficiency in Turkish adults. Endocrine Abstracts 2013;32:P135.
• [22] Klawansky S, Komaroff E, Cavanaugh PF Jr, Mitchell DY, Gordon MJ, Connelly JE, et al. Relationship between age, renal function and bone mineral density in the US population. Osteoporos Int 2003;14:570-6.
• [23] Jassal SK, von Muhlen D, Barrett-Connor E. Measures of renal function, BMD, bone loss, and osteoporotic fracture in older adults: the Rancho Bernardo study. J Bone Miner Res 2007;22:203-10.
• [24] Hsu CY, Cummings SR, McCulloch CE, Chertow GM. Bone mineral density is not diminished by mild to moderate chronic renal insufficiency. Kidney Int 2002;61:1814-20.
• [25] Jamal SA, Swan VJ, Brown JP, Hanley DA, Prior JC, Papaioannou A, et al. Kidney function and rate of bone loss at the hip and spine: the Canadian Multicentre Osteoporosis Study. Am J Kidney Dis 2010;55:291-9.
• [26] Grzegorzewska AE, Młot-Michalska M. Influence of age and sex on bone mineral density in dialysis patients. Adv Perit Dial 2007;23:77-81.
• [27] Dooly AC, Weiss NS, Kestenbaum B. Increased risk of hip fracture among men with CKD. Am J Kidney Dis 2008;51:38-44.
• [28] Hesegawa K, Hasegawa Y, Nagano A. Estimation of bone mineral density and architectural parameters in the distal radius in hemodialysis patients using peripheral quantitative computed tomography. J Biomechan 2004;37:751-6.
• [29] Billy HT, Rimkus DR, Hartzman S, Latimer RG. Technetium-99m-sestamibi single agent localization versus high resolution ultrasonography for the preoperative localization of parathyroid glands in patients with primary hyperparathyroidism. Am Surg 1995;61:882-8.
• [30] Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m) technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002;57:241-9.
• [31] Périé S, Fessi H, Tassart M, Younsi N, Poli I, St Guily JL, et al. Usefulness of combination of high-resolution ultrasonography and dual-phase dual-isotope iodine 123/technetium Tc 99m sestamibi scintigraphy for the preoperative localization of hyperplastic parathyroid glands in renal hyperparathyroidism. Am J Kidney Dis 2005;45:344-52.
• [32] Vulpio C, Bossola M, De Gaetano A, Maresca G, Bruno I, Fadda G, et al. Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism. Head Neck 2010;32:1226-35.