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Abstract: FR-PO298

High Prevalence of Aluminum Deposition in Bone and Osteoporosis in CKD Patients: Data from the Brazilian Registry of Bone Biopsy (REBRABO)

Session Information

Category: Mineral Disease

  • 1202 Mineral Disease: Vitamin D, PTH, FGF-23

Authors

  • Carbonara, Cinthia Esbrile Moraes, University of Campinas, Campinas, Brazil
  • dos Reis, Luciene, University of São Paulo, São Paulo, Brazil
  • Franca, Renata Almeida, University of Campinas, Campinas, Brazil
  • Quadros, Kelcia Rosana da Silva, University of Campinas, Campinas, Brazil
  • Esteves, André Barros Albuquerque, University of Campinas, Campinas, Brazil
  • Roza, Noemi Angelica Vieira, University of Campinas, Campinas, Brazil
  • Jorgetti, Vanda, University of São Paulo, São Paulo, Brazil
  • de Oliveira, Rodrigo B., University of Campinas, Campinas, Brazil
Background

Mineral and bone disorder (MBD) due CKD is related with significant morbidity and mortality. REBRABO is a database wich contains information about Brazilian CKD patients with MDB.

Methods

Clinical, demographics, laboratorial, imaging, and bone histology data were collected from CKD patients between Aug/15-Apr/17. Diagnose of aluminum (Al) intoxication was when Al covered ≥30% of bone surface by solochrome-azurine; diagnose of osteoporosis was considered either by T score ≤2.5 S.D. or decreased bone volume detected by bone biopsy (BB).

Results

Data from 175 patients who were submitted to BB were analyzed. Patients aged 51±13 years, 89 (51%) men and 81(46%) white; 34 (19%) patients had history of bone fracture; symptoms of bone pain, weakness or myalgia were observed in 87 (51%) patients. Serum intact parathormone, alkaline phosphatase, calcium, and phosphate levels were 450 (58-500) pg/mL, 165 (73-250) IU/L, 9.2±1 mg/dL and 4.9±1.6 mg/dL, respectively. The main indication for BB was clinical protocol in 78 (45%) and suspected Al intoxication in 41 (23%) patients. Fibrous osteitis (FO) was detected in 67 (38%), mixed bone disease in 26 (15%), adynamic bone disease in 21 (12%) and osteomalacia in 6 (3,4%). Dialysis modalitity had no correlation with the type of renal osteodistrophy (ROD). Al intoxication was prevalent in 38 (22%); osteoporosis was present in 27 (15%) by bone densitometry and 54 (31%) by BB. Patients with osteoporosis diagnosed by BB presented higher prevalence of fracture (p=0.001).

Conclusion

FO was the main type of ROD in Brazil. A high prevalence of Al intoxication was detected. Osteoporosis when diagnoses by BB, but not by bone densitometry, was related with fractures. BB remains the gold standard for the differential diagnosis of ROD, as well as osteoporosis in CKD patients. Future studies are needed to clarify the clinical impact of Al intoxication in these patients.