Low bone turnover is associated with plain X-ray vascular calcification in predialysis patients

Autores da FMUP

• Ricardo Morais Pereira Neto

  Autor

• Janete Maria Quelhas Dos Santos

  Autor

• João Miguel Machado Dória Frazão

  Autor

Participantes de fora da FMUP

• Pereira, L
• Magalhaes, J

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina

• Recursos Comuns

  

  Investigador

  Guilhermina Maria Da Silva Rêgo

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Background Vascular calcification (VC) is a common finding in chronic kidney disease (CKD) patients and predicts subsequent cardiovascular morbidity and mortality in this population. Vascular calcification is linked to disordered mineral metabolism and has been associated with bone histomorphometry changes in CKD. However, data on predialysis patients is scarce. Methods A cross-sectional study was conducted on a cohort of 56 CKD patients not yet on dialysis, who underwent a transiliac bone biopsy for histomorphometric evaluation after double tetracycline labeling. Patients had no previous exposure to calcium salts, vitamin D agents, steroids or bisphosphonates. Vascular calcification was assessed at the time of biopsy, using Kauppila (plain X-ray of the lateral lumbar spine) and AdragAo (plain X-ray of the pelvis and hands) scores. Results Vascular calcification was seen in two-thirds of the cohort. Subjects with VC were more likely to be male and have diabetes, and had significantly higher sclerostin and osteoprotegerin circulating levels than those without VC. The histomorphometric analysis showed that bone formation rate was significantly lower in VC compared to non-VC patients. In the multivariable logistic regression analysis, bone formation rate was independently associated with the presence of VC. Conclusions Vascular calcification is highly prevalent in predialysis patients, especially in those with diabetes. The independent association between bone formation rate and VC provides evidence of an important interaction between bone and vessel in CKD. Our results suggest that low bone turnover is a non-traditional risk factor for cardiovascular disease in predialysis patients.

Keywords

• Aged; Bone and Bones; Bone Remodeling; Female; Humans; Male; Middle Aged; Multivariate Analysis; Regression Analysis; Renal Dialysis; Renal Insufficiency, Chronic; Vascular Calcification; X-Rays; doxycycline; osteoprotegerin; sclerostin; adult; aged; Article; blood vessel calcification; bone biopsy; bone turnover; cardiovascular disease; cardiovascular risk; chronic kidney failure; cohort analysis; cross-sectional study; diabetes mellitus; drug labeling; female; hand radiography; hemodialysis; human; lumbar spine; major clinical study; male; middle aged; morphometry; observational study; ossification; pelvis radiography; prevalence; sex difference; spine radiography; blood vessel calcification; bone; bone remodeling; chronic kidney failure; complication; diagnostic imaging; multivariate analysis; pathology; pathophysiology; physiology; regression analysis; X ray