Kidney Week

Abstract: FR-PO0241

Histological Bone Formation Rates in CKD Bone Biopsies Differ Between Trabecular and Intracortical Compartments with Poor Predictive Ability of Systemic Markers of Bone Turnover

Session Information

• Bone and Mineral Metabolism: Clinical Epidemiology and Outcomes
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Metzger, Corinne E., Indiana University School of Medicine, Indianapolis, Indiana, United States

Corinne E. Metzger, PhD

• Allen, Matthew R., Indiana University School of Medicine, Indianapolis, Indiana, United States

Matthew R. Allen, PhD

• O'Neill, Kalisha, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kalisha O'Neill

• Chen, Neal X., Indiana University School of Medicine, Indianapolis, Indiana, United States

Neal X. Chen, PhD

• Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States

Sharon M. Moe, MD, FASN

• Moyses, Rosa M.A., Universidade de Sao Paulo, São Paulo, SP, Brazil

Rosa M.A. Moyses, MD, PhD

• McMahon, Donald J., Columbia University, New York, New York, United States

Donald J. McMahon, MS

• Nickolas, Thomas L., Washington University in St Louis School of Medicine, St. Louis, Missouri, United States

Thomas L. Nickolas, MD, MS, FASN

Background

Chronic kidney disease (CKD) alters bone metabolism and leads to high fracture rates. Because bone turnover in CKD falls across a spectrum of low-to-high, tetracycline labeled bone biopsies are the standard for assessing the bone turnover phenotype. Standard measures of bone biopsies often focus on trabecular bone; however, CKD leads to dramatic alterations to cortical bone structure.

Methods

In the current study, we aimed to determine whether dynamic histomorphometry of trabecular (Tb) and intracortical (Ic) bone formation rates (BFR) are related using 131 iliac crest biopsies from CKD patients. In a subset of 95 biopsies, we investigated regression analyses between systemic serum markers of bone turnover (parathyroid hormone [PTH] and bone specific alkaline phosphatase [BSAP]) and BFR.

Results

Spearman’s rho shows a moderate relationship between Tb BFR and Ic BFR (ρ=0.53). Serum PTH had similar predictive value to both Tb and Ic BFR (R²=0.41, R²=0.42). Serum BSAP had a stronger relationship with Ic BFR (R²=0.55) than with Tb BFR (R²=0.28). When assessing ranked BFR values between Tb and Ic sites, ~30% of the total 131 biopsies showed mismatched ranks with a difference of 40 or greater in ranked values – 16% of the total cohort had Tb BFR higher than Ic BFR and 14% had Tb BFR lower than Ic BFR.

Conclusion

These data indicate that assessing both Tb and Ic BFR in CKD biopsies may provide a more complete analysis of bone turnover given the discrepancy between Ic and Tb BFR in a third of the patients. Furthermore, serum PTH and BSAP are not strongly related to bone formation rate at either site within this cohort indicating the need for improved methods to predict bone turnover within this population.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025y72m9w7r