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Abstract: PO0400

Differences in Bone Biomarkers by Renal Osteodystrophy Pathology

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Laster, Marciana, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Pereira, Renata C., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Salusky, Isidro B., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
Background

The gold standard for the diagnosis of Renal Osteodystrophy (ROD) remains the iliac crest bone biopsy. Given its limited availability, it is important to consider whether serum markers of bone metabolism will allow the ability to predict ROD type. Here we assess how major markers of bone metabolism differ by ROD category.

Methods

93 pediatric patients with CKD underwent measurement of calcium, phosphate, alkaline phosphate (ALP), PTH, intact and c-terminal FGF23, sclerostin and TRAP5B at the time of bone biopsy. Patients were categorized by ROD diagnoses and biomarker comparisons were made according to turnover and mineralization status. Comparisons of bone markers within each category were made using the Wilcoxin Rank Sum test.

Results

Cohort characteristics are presented in Table 1. Of the ROD categories, 30.1% had normal bone, 30.1% adynamic bone disease, 11.8% mixed uremic osteodystropy, 14% osteitis fibrosa cystica, 4.3% osteomalacia and the remainder unknown disease. Those with high turnover disease had greater ALP (p<0.0001) and PTH (p=0.001) and lower calcium (p=0.04) than those with non-high turnover disease. Of those with low turnover bone disease, TRAP5B (p=0.01) and ALP (p=0.0003) were significantly lower and calcium (p=0.03) higher as compared to those with non-low turnover disease. In those with a mineralization defect, ALP (p=0.001) was higher and sclerostin (p=0.02) lower than those without a defect (Figure 1).

Conclusion

Comparisons within ROD categories demonstrate differences in serum biochemical markers. With further study, these differences may help to predict the type of CKD-related bone lesion without the need for bone biopsy. Promising markers such as TRAP5B, which is unaffected by renal function, may be valuable in distinguishing low turnover disease but this requires further investigation.

Funding

  • NIDDK Support