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Impaired Parathyroid Function and Bone Formation: A Risk for Development of Adynamic Bone Disease to Enhance Vascular Calcification

  • Shinsuke YamadaEmail author
Chapter

Abstract

The prognosis of diabetes mellitus (DM) patients on hemodialysis (HD) is markedly worse than for non-DM HD patients. One of the causes for poor prognosis in DM HD patients is pointed out: the presence of specific bone metabolic disorders. Bone metabolic abnormalities are closely related to the onset of vascular calcification, and both of these complications are thought to be caused by inappropriate glycemic control. Because osteoblast/osteocyte function is impaired and parathyroid hormone (PTH) secretion ability is suppressed under the sustained hyperglycemic status, bone turnover becomes low and adynamic bone disease (ABD) is exhibited. As a direct result of ABD, cushioning action of serum calcium and phosphorus on the bone is weakened, in addition to vascular calcification.

Meanwhile, both hyperinsulinemia and obesity positively affect bone status. Accordingly, these factors should have been excluded to investigate the influences of glycemic control alone on bone status. We will give an outline into focus on DM HD patients who are not obese and generally have depleted insulin secretion ability.

Keywords

Hyperglycemia Bone turnover Adynamic bone Vascular calcification 

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Copyright information

© Springer Japan 2016

Authors and Affiliations

  1. 1.Metabolism, Endocrinology, and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan

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