Abstract: PO0577
Role of Current Proposed Algorithm to Guide Osteoporosis Treatment in CKD: A Bone Biopsy Study
Session Information
- Bone and Mineral Metabolism: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Dupuis, Marie-Eve, CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
- Khelifi, Nada, CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
- Labrecque, Myriam, CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
- Picard, Sylvain, Centre de recherche du CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
- Nickolas, Thomas, Columbia University, New York, New York, United States
- Evenepoel, Pieter, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Flanders, Belgium
- Lafage-proust, Marie-helene, Inserm U1059, université de Lyon, université J. Monnet, Saint-Étienne, France
- Mac-Way, Fabrice, CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
Background
Recently, algorithms have been proposed to guide osteoporosis treatment in chronic kidney disease population. As suggested by Kharaillah et al, evaluation of bone turnover level by bone specific phosphatase alkaline (bALP) will determine the use of anabolic or antiresorptive therapy with or without prior bone biopsy. The aim of this study is to use a cohort of CKD patients who had a bone biopsy to evaluate accuracy of this algorithm in a real-world setting.
Methods
Single-center retrospective cross-sectional study at CHU de Québec, Canada from 2017 to 2021. CKD 4-5 patients with bone fragility and suspicion of low bone turnover or mineralization defects who had a bone biopsy were included. Results of bone biopsy were categorized based on the TMV classification. We compared the performance of the algorithm to identify potential contraindications to antiresorptive or anabolic therapy vs bone biopsy results. Receiver operating characteristic (ROC) curves were used to explore the predictive ability of bALP and tALP regarding low bone turnover and potential contraindication to antiresorptive therapy in our cohort.
Results
Twenty-six patients included (mean age 67,7 years, 11 men, 14 HD and 1 PD, 11 diabetic patients). Eleven patients had low, 8 normal and 7 high bone turnover on biopsy. According to the algorithm, no patient would have received anabolic treatment, bone biopsy would have been proposed to 10 patients and 16 would have received antiresorptive therapy. Based on the biopsy results, 8 out of these 16 patients had potential contraindications: 4 with low bone turnover and 4 with presence of mineralization defects. ROC curve for bPAL to predict low bone turnover was 0,749 (similar to tPAL). However, the AUC for bPAL to predict the presence of potential contraindication to antiresorptive was lower at 0,6667 (0,6095 for tPAL).
Conclusion
Algorithm using bone turnover markers can guide clinicians in approaching these patients. However, bone biopsy is still needed in many patients to better tailor anti fracture therapy until more accurate non-invasive markers are available.
Funding
- Private Foundation Support