Comparison of clinical, biochemical and histomorphometric analysis of bone biopsies in dialysis patients with and without fractures
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Chronic kidney disease-mineral bone disorders (CKD-MBD) are associated with increased risk of fracture. Studies report about 3% of fractures in CKD patients, and these occur earlier than in the general population, namely 16 and 13 years earlier for men and women, respectively. Better understanding of the pathophysiology of fractures would probably contribute to new therapeutic approaches. This study aimed to evaluate report of long bone fractures from a bone biopsies bank from patients on hemodialysis and compare clinical and biochemical characteristics, as well as the results of the histomorphometric analysis of trabecular and cortical bone of these patients with a control group (without fractures), paired for age, gender, and time on hemodialysis. Bone proteins (SOST, DMP1 and MEPE) were evaluated by immunohistochemistry. Seventeen patients with fracture and controls were studied. Fracture prevalence was 0.82/1000 patients/year. Serum phosphorus levels were significantly lower in the fracture group. Histomorphometric analysis revealed that all the patients had high turnover disease, and the fracture group had smaller volume and trabecular thickness, greater osteoid surface, smaller eroded surface, smaller mineralizing surface, formation rate and longer mineralization lag time when compared to controls; the DMP1 expression in the cortical bone was smaller and the SOST in the trabecular bone was higher in fractured patients. As conclusion, we found low prevalence of fractures. Both groups had high turnover disease, but the fractured ones presented more impaired bone microarchitecture, as well as lower formation and greater mineralization defect. Bone proteins expression correlated with parameters involved in bone remodeling.
KeywordsFracture CKD-MBD Bone turnover Histomorphometry Immunohistochemistry
This study was presented, in part, at the 2017 World Congress of Nephrology in Mexico City, Mexico. The results presented in this paper have not been published previously in whole or part, except in abstract format. The authors thank Rosimeire A. B. Costa for the technical support.
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Conflict of interest
Rosa M. A. Moysés, Vanda Jorgetti and Aluizio B. Carvalho have received lecture fees and are consultant to Sanofi, Abbott do Brasil, and Amgen. All other authors have no conflict of interest.
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