Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease

Alastair J. Hutchison, Rick W. Whitehouse, Helen F. Boulton, Judy E. Adams, E. Barbara Mawer, Tony J. Freemont, Ram Gokal

    Research output: Contribution to journalArticlepeer-review

    Abstract

    We analyzed transiliac bone biopsy specimens from 30 end-stage renal failure patients, taken at the time of admission for CAPD training. Results were compared with values of iPTH, bone alkaline phosphatase, 1,25-dihydroxyvitamin D3, skeletal survey, quantitative computed tomography (QCT) and single photon absorptiometry (SPA) bone density measurements. Osteitis fibrosa was the most common histological diagnosis, present in 15 of the 30 patients (50%), with eight classified as "severe" and seven as "mild." Eight patients (27%) had adynamic bone lesion, four mixed renal osteodystrophy (13%), and two (7%) osteomalacia. The mean age of the adynamic group was higher than the osteitis fibrosa group (41 ± 12.1 vs. 56 ± 10.2 years; P <0.01), and than the mixed group (39 ± 7.5 vs. 56 ± 10.2 years; P <0.02). Levels of iPTH enabled discrimination between groups, but not between individual patients, and values correlated with bone alkaline phosphatase (r = 0.62; P <0.001). Erosion of the terminal phalanges was seen on the plain X-rays of 7 of 15 patients with mild or severe OF, and in three patients with another diagnosis. The majority of patients (>90%) had bone density measurements within the normal range. No significant correlation existed between QCT or SPA scores and any of the histomorphometric parameters, or iPTH. We conclude that iPTH is the most helpful non-invasive investigation in this group of patients. Plain X-ray of the hands is the most useful radiological investigation, but single measurements of bone density are not diagnostic.
    Original languageEnglish
    Pages (from-to)1071-1077
    Number of pages6
    JournalKidney International
    Volume44
    Issue number5
    Publication statusPublished - Nov 1993

    Keywords

    • Adult
    • Aged
    • Biopsy
    • Bone Density
    • metabolism: Bone and Bones
    • metabolism: Cholecalciferol
    • Female
    • etiology: Fibrous Dysplasia of Bone
    • Humans
    • complications: Kidney Failure, Chronic
    • Male
    • Middle Aged
    • etiology: Osteomalacia
    • metabolism: Parathyroid Hormone
    • Radioimmunoassay
    • Research Support, Non-U.S. Gov't
    • Tomography, X-Ray Computed

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