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Abstract: PO0404

Low Bone Turnover and Increasing Calcification with Lower Trabecular Bone Score in Early CKD Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Mohamed, Amr El-Husseini, University of Kentucky, Lexington, Kentucky, United States
  • Ahmed, Mohamed, University of Kentucky, Lexington, Kentucky, United States
  • Winkler, Michael, University of Kentucky, Lexington, Kentucky, United States
  • Srour, Habib, University of Kentucky, Lexington, Kentucky, United States
  • Davenport, Daniel, University of Kentucky, Lexington, Kentucky, United States
  • Faugere, Marie-Claude M., University of Kentucky, Lexington, Kentucky, United States
  • Malluche, Hartmut H., University of Kentucky, Lexington, Kentucky, United States

Group or Team Name

  • University of Kentucky
Background

Little information is available on turnover abnormalities early during the development of loss of kidney function. Vascular calcifications may develop in association with bone turnover abnormalities. This study was designed to evaluate bone changes and cardiovascular calcification in early CKD patients without clinically known bone or cardiovascular disease.

Methods

This is a cross-sectional analysis of 32 adult volunteers with CKD stage 2-4. All patients underwent 1) dual energy x-ray absorptiometry including trabecular bone score (TBS). 2) Non-contrast CT for cardiovascular calcium scoring, and 3) anterior iliac crest bone biopsy after double tetracycline-labelling and mineralized bone histology with histomorphometry.

Results

The mean age of the patients was 61±11 years. Patients tended to be obese (75%), white (72%), and female (59%). The mean eGFR was 44±16 ml/min/1.73 m2. On bone histology low turnover was found at the higher eGFR levels in 78% and normal or high turnover at lower eGFR levels. Mineralization was normal in all. Bone volume was normal in 75% and slightly low in the others. Correlation between bone parameters and eGFR are shown in Table 1. Coronary artery calcium (CAC) score was above 400 in 31%, between 100 and 400 in 24%%, and less than 100 in 45% of patients. TBS correlated negatively with CAC-scores (rho -0.43, p=0.023), and with aortic calcium scores (rho -0.62, p <0.001) (Figure 1)

Conclusion

Low bone turnover, normal total bone volume and absence of mineralization defect are seen in early stages of CKD. There are increased vascular calcifications with low TBS pointing to a relationship between bone quality and vascular calcifications.