Densidad mineral y metabolismo óseo en pacientes en hemodiálisis. Correlación con la hormona paratifoidea, el 25(OH)D3 y la leptina

Polymeris, A.; Doumouchtsis, K.; Grapsa, E.

doi:10.3265/Nefrologia.pre2011.Jul.10916

Article information

Antecedentes: Los trastornos del metabolismo óseo en pacientes en hemodiálisis (HD) implican varios factores humorales, de los cuales la función central recae sobre la hormona paratiroidea. Cuando hay insuficiencia renal normalmente se detectan niveles elevados de leptina y su relación con el metabolismo óseo está aún por esclarecer. Investigamos la densidad mineral ósea (DMO) y el metabolismo óseo en relación con la hormona paratiroidea sérica, el 25(OH)D3 y la leptina en pacientes en HD. Métodos: Medimos la fosfatasa alcalina ósea (FAO), el telopéptido N, la hormona paratiroidea, el 25(OH)D3 y la leptina en 37 pacientes en HD. Asimismo, evaluamos el IMC y la DMO en la columna lumbar (CL) y en el cuello femoral (CF) mediante DXA. Las evaluaciones estadísticas se basaron en análisis de regresión simples. Entrecruzamiento del telopéptido N del colágeno óseo tipo I. Resultados: 1) De nuestros pacientes, el 32,1% presentaba osteopenia en CL y 50% en CF y el 14,3% y el 21,4% osteoporosis, respectivamente. El puntaje Z en CL o CF no estaba relacionado con la duración de la HD. 2) Los marcadores óseos, la hormona paratiroidea, y los niveles de fósforo y leptina se vieron incrementados. 3) El 25(OH)D3 era bajo y no estaba relacionado con el telopéptido N, la FAO o la hormona paratiroidea. 4) La hormona paratiroidea estaba correlacionada con los marcadores óseos y con el puntaje Z en CL y CF. 5) La leptina no presentaba correlación con los marcadores óseos o con el puntaje Z (con excepción del IMC). Conclusiones: En nuestros pacientes en hemodiálisis, los marcadores del metabolismo óseo se vieron incrementados en relación con los niveles elevados de hormona paratiroidea sérica. La elevada leptina sérica observada no estaba asociada al metabolismo óseo. Además, la duración de la hemodiálisis no pareció afectar a la densidad ósea.

Palabras clave:

Hormona paratiroidea

Palabras clave:

Leptina

Palabras clave:

Hemodiálisis

Palabras clave:

Metabolismo óseo

Palabras clave:

Vitamina D3

Palabras clave:

Densidad mineral ósea

Background: Bone metabolism disorders in hemodialysed patients (HD) involve several humoral factors, of which PTH plays the central role. Leptin is usually found increased in renal failure and its link with bone metabolism has not been elucidated. We investigated the BMD and bone metabolism in association with serum PTH, 25OHD3 and leptin in HD patients. Methods: We measured bone alkaline phosphatase (bSAP), cross linked N telopeptide of type 1 collagen (NTx), PTH, 25OHD3 and leptin in 37 HD patients. We also evaluated BMI and BMD in lumbar spine (LS) and in femoral neck (FN) by DXA. Statistical evaluations were based on simple regression analysis. Results: 1) Osteopenia was found in 32,1% in LS and 50% in FN and osteoporosis in 14.3% and 21.4% of our patients, respectively. LS or FN Z score was not related to HD duration. 2) Bone markers, PTH, phosphorus and leptin levels were increased. 3) 25OHD3 was low and was not related to NTx, bSAP or PTH. 4) PTH correlated with bone markers and Z score in LS and FN. 5) Leptin had no correlation with bone markers or Z score (except BMI). Conclusions: In our hemodialysed patients bone metabolism markers were increased in relation with high serum PTH levels. The observed high serum leptin was not associated with bone metabolism. Additionally the duration of hemodialysis did not appear to affect bone density.

Keywords:

PTH

Keywords:

Leptin

Keywords:

Hemodialysis

Keywords:

Bone metabolism

Keywords:

Vitamin D3

Keywords:

Bone mineral density

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Bibliografía

[1]

Hruska KA, Teitelbaum SL. Mechanisms of disease: renal osteodystrophy. N Engl J Med 1995;333(3):166-74. [Pubmed]

[2]

Yamamoto N. Morphological analysis of bone dynamics and metabolic bone disease. Bone Histomorphometry in CKD-MBD (chronic kidney disease mineral bone disorder). Clin Calcium 2011;21(4):589-92. [Pubmed]

[3]

De Vernejoul MC, Kuntz D, Miravet L, Gueris J, Bielakoff J, Ryckewaert A. Bone histomorphometry in hemodialysed patients. Metab Bone Dis Rel Res 1981;3:175-9.

[4]

Yamamoto N. Morphological analysis of bone dynamics and metabolic bone disease. Bone Histomorphometry: the basic methods and role of bone research and clinical significance. Clin Calcium 2011;21(4):529-33.

[5]

Sherrard D, Hercz G, Pei Y. The spectrum of bone disease in end stage renal failure-an evolving disorder. Kidney Int 1993;43(2):436-42. [Pubmed]

[6]

Taal M, Masud T, Green D, Cassidy M. Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant 1999;14:1922-8. [Pubmed]

[7]

Atsumi K, Kushida K, Yamazaki K, Shimizu S, Ohmura A, Inoue T. Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis 1999;33(2):287-93. [Pubmed]

[8]

Urena P, De Vernejoul MC. Circulating markers of bone remodeling in uremic patients. Kidney Int 1999;55:2141-56. [Pubmed]

[9]

Ghazali A, Fardellone P, Pruna A, Atik A, Achard JM, Oprisiu R, et al. Is low plasma 25-(OH)vitamin D a major risk factor for hyperparathyroidism and Looser¿s zones independent of calcitriol? Kidney Int 1999;55(6):2169-77.

[10]

Thomas T, Gori F, Khosla S. Leptin acts on human marrow stromal cells to enhance differentiation to osteoblasts and to inhibit differentiation to adipocytes. Endocrinology 1999;140(4):1630-8.

[11]

Holloway WR, Collier FM, Aitken CJ. Leptin inhibits osteoclast generation. J Bone Miner Res 2002;17:200-9. [Pubmed]

[12]

Tsuji K, Maeda T, Kawane T, Matsunuma A, Horiuchi N. Leptin stimulates fibroblast growth factor 23 expression in bone and supresses renal 1alpha 25-dihydroxyvitamin D3 synthesis in leptin deficient mice. J Bone Miner Res 2010;25(8):1711-23. [Pubmed]

[13]

Steppan CM, Crawford DT, Chidsey-Fink KL, Ke H, Swick AG. Leptin is a potent stimulator of bone growth in ob/ob mice. Regul Pept 2000;92(1-3):73-8. [Pubmed]

[14]

Ducy P, Amling M, Takeda S, Priemel M, Schilling AF, Beil FT, et al. Leptin inhibits bone formation through a hypothalamic relay: a central role of bone mass. Cell 2000;100(2):197-207. [Pubmed]

[15]

Song J, Li H, Zhang XD. Influence of diferent bpood purification treatment on the serum leptin and neuropeptide Y levels in patients with chronic renal failure. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2010;26(11):1116-8. [Pubmed]

[16]

Taskapan MC, Taskapan H, Sahin I, Keskin L, Atmaca H, Ozyalin F. Serum leptin, resistin and lipid levels in patients with end stage renal failure with regard to dialysis modality. Ren Fail 2007;29(2):147-54. [Pubmed]

[17]

Mantzoros CS. Leptin in renal failure. J Ren Nutr 1999;9(3):122-5. [Pubmed]

[18]

Mallamaci F, Tripepi G, Zoccali C. Leptin in end stage renal disease (ESRD): a link between fat mass, bone and the cardiovascular system. J Nephrol 2005;18(4):464-8. Review. [Pubmed]

[19]

19. Ghazali A, Grados F, Oprisiu R, Bunea D, Moriniere P, El Esper N, et al. Bone mineral density directly correlates with elevated serum leptin in haemodialysis patients. Nephrol Dial Transplant 2003;18:1882-90. [Pubmed]

[20]

Zayour D, Daouk M, Medawar W, Salamoun M, El-Hajj Fuleihan G. Predictors of bone mineral density in patients on hemodialysis. Transplant Proc 2004;36(5):1297-301. [Pubmed]

[21]

Urena P, Bernard-Poenaru O, Ostertag A. Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 2003;18:2325-31. [Pubmed]

[22]

Doumouchtsis KK, Kostakis AI, Doumouchtsis SK, Tziamalis MP, Stathakis CP, Diamanti-Kandarakis E, et al. Associations between osteoprotegerin and femoral neck BMD in haemodialysis patients. J Bone Miner Metab 2008;26(1):66-72. Epub 2008 Jan 10. [Pubmed]

[23]

Negri A, Álvarez-Quiroga M, Bravo M, Fradinger E, Jacob de Marino A. Estimation of the prevalence of low turnover renal osteodystrophy using biochemical markers in a peritoneal dialysis population. Nefrologia 2001;21(4):392-4. [Pubmed]

[24]

Fontaine M, Albert A, Dubois R, Saint-Remy A, Rorive G. Fracture and bone mineral density in hemodialysis patients. Clin Nephrol 2000;54:218-26. [Pubmed]

[25]

Yamaguchi T, Kanno E, Tsubota J, Shiomi T, Nakai M, Hattori S. Retrospective study on the usefulness of radius and lumbar bone density in the separation of hemodialysis patients with fractures from those without fractures. Bone 1996;19:549-55. [Pubmed]

[26]

Stein MS, Packham DK, Ebeling PR, Wark JD, Becker GJ. Prevalence and risk factors for osteopenia in dialysis patients. Am J Kidney Dis 1996;28:515-22. [Pubmed]

[27]

Montagnani A, Gonnelli S, Cepollaro C, Mangeri M, Martini S, Franci MB, et al. A new serum assay to measure N-terminal fragment of telopeptide of type 1 collagen in patients with renal osteodystrophy. Eur J Intern Med 2003;14:172-7.

[28]

Nakashima A, Yorioka N, Mizutani T, Yamagata Z, Ueno T, Takasugi N. Serum cross-linked N-terminal telopeptide of type 1 collagen for evaluation of renal osteodystrophy in hemodialysis patients. Nephron Clin Pract 2005;99:c78-c85. [Pubmed]

[29]

Van der Wielen RP, Lowik MR, Van den Berg H, De Groot L, Haller J. Serum vitamin D concentrations in elderly in Europe. Lancet 1995;346:207-10. [Pubmed]

[30]

Thomas MK, Lloyd Jones DM, Thadam AJ, Shaw AC, Fikelstein R. Hypovitaminosis D in medical inpatients. N Engl J Med 1998;338:777-83. [Pubmed]

[31]

Bayard F, Bey P, Ton That M, Louvet J. Plasma 25OH cholecalciferol in chronic renal failure. Eur J Clin Invest 1973;3:447-50. [Pubmed]

[32]

Pasco JA, Henry MJ, Kotowicz MA, Collier GR, Ball MG. Serum leptin levels are associated with bone mass in nonobese women. J Clin Endocrinol Metab 2001;86(5):1884-7. [Pubmed]

[33]

Yamauchi M, Sugimoto T, Yamaguchi T, Naganuma S, Akiyama Y, Nuki Y, et al. Plasma leptin concentrations are associated with bone mineral density and the presence of vertebral fractures in post-menopausal women. Clin Endocrinol (Oxf) 2001;55(3):341-7.

[34]

34. Blain H, Vuillemin A, Guillemin F, Durant R, Hanesse B, De Talance N, et al. Serum leptin levels is a predictor of bone mineral density in postmenopausal women. J Clin Endocrinol Metab 2002;879(3):1030-5.

[35]

Rauch F, Blum WF, Klein K, Allolio B, Schonau E. Does leptin have an effect on bone in adult women? Calcif Tissue Int 1998;63:453-5. [Pubmed]

[36]

Odabasi E, Ozata M, Turan M, Bingol N, Yonem A, Cakir B, et al. Plasma leptin concentrations in post menopausal women with osteoporosis. Eur J Endocrinol 2000;142(2):170-3. [Pubmed]

[37]

Thomas T, Burguera B, Melton LJ 3rd, Atkinson EJ, O¿Fallon WM, Riggs BL, Khosla S. Role of serum leptin, insulin and estrogen levels as potential mediators of the relationship between fat mass and bone mineral density in men versus women. Bone 2001;29(2):114-20. [Pubmed]

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