Aug 2026· Archives of Osteoporosis· Vol 21· 0 citations· 22 references
Medicine
TL;DR
In patients with stage 3 CKD and stable renal function, bone microarchitecture identified impaired BMD not fully detected by DXA, and over 1 year, only minimal changes in bone parameters were observed.
Abstract
In a 1-year longitudinal study of 34 patients with stage 3 CKD and stable bone turnover markers there was no deterioration of bony quality. However, HR-pQCT identified impaired bone density in 73.5% of cases at baseline, which was undetected by DXA. Findings suggest early skeletal involvement despite stable renal function. It has been postulated that chronic kidney disease (CKD) is associated with bone loss. However, prospective data are limited, and it remains unclear whether bone loss or microarchitecture chances occurs in the early stages of CKD with stable renal function. In this longitudinal cohort study, patients with stage 3 CKD underwent dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT), with reassessment after 1 year. Bone biomarkers, including alkaline phosphatase, intact parathyroid hormone (iPTH), intact fibroblast growth factor-23 (iFGF-23), total procollagen type 1 N-terminal propeptide (tP1NP), and β-isomerized C-terminal telopeptide of type I collagen -I (β-CTX-I) were also measured. Thirty-four patients were included (51 ± 3 years, 44% men). Bone turnover markers remained stable during follow-up. Osteopenia and/or osteoporosis at one or more sites was found in 45.5% of participants. Low bone mineral density (BMD), T-score < -1, was observed in 32.3% (lumbar spine), 29.4% (total hip), 14.7% (1/3 distal radius), and 26.5% (ultradistal radius). HR-pQCT revealed impaired BMD in at least one site (tibia or radius) in 73.5% of cases. Renal function remained stable during follow-up, with no significant changes in bone biomarkers. DXA showed a slight but significant decline in T-scores at the total hip and 1/3 distal radius, whereas HR-pQCT parameters remained unchanged. In patients with stage 3 CKD and stable renal function, bone microarchitecture identified impaired BMD not fully detected by DXA. Over 1 year, however, only minimal changes in bone parameters were observed.
Background Chronic kidney disease (CKD) is associated with increased fracture risk not fully explained by reduced bone mineral density. CKD–mineral and bone disorder (CKD-MBD), involving abnormalities in bone turnover, mineralization, and microarchitecture, contributes to skeletal fragility. However, the relationship between routine biochemical markers and semi-quantitative bone histomorphometry remains inadequately defined, particularly in resource-limited settings and the Indian population. The objective of this study was to compare biochemical markers and semi-quantitative bone histomorphometric findings in CKD patients with and without fractures. Methods In this hospital-based comparative cross-sectional study, 48 patients with CKD stage 3–4 were divided into fracture (n = 24) and non-fracture groups (n = 24). Serum calcium, 25-hydroxyvitamin D, parathyroid hormone (PTH), and alkaline phosphatase (ALP) were measured. Bone samples were obtained intraoperatively or via transiliac crest biopsy. Semi-quantitative bone histomorphometry was assessed by a pathologist. Statistical analysis included appropriate group comparisons. Results Fracture patients had significantly lower vitamin D (p = 0.007) and calcium (p = 0.005), and higher PTH (p = 0.002) and ALP (p = 0.001). Semi-quantitative histomorphometric evaluation showed increased osteoid volume, reduced trabecular thickness, and elevated osteoblastic and osteoclastic activity. Conclusion In our study cohort, CKD patients with fractures exhibited a high-turnover bone phenotype with increased osteoid volume and altered bone histology. Biochemical markers may serve as cost-effective adjuncts for fracture risk stratification, particularly where advanced diagnostics are limited. Findings should be interpreted cautiously given the cross-sectional design and small sample size.
Sushil Sharma, P. Sujir, Pranav Rajasekharan et al.· SAGE Open Medicine· 0 citations
BACKGROUND
Chronic kidney disease (CKD) disrupts mineral and bone metabolism, increasing fracture risk. Exercise may improve physical performance and help preserve bone mineral density (BMD), but data on the relationship between BMD and bone turnover markers during long-term exercise in CKD are limited. We explored potential associations between intact procollagen type I N-propeptide (intact PINP), tartrate-resistant acid phosphatase 5b (TRAP5b) and BMD in CKD stages 3-5 patients completing 12 months of exercise.
METHODS
In this post-hoc, exploratory analysis of the RENEXC trial, 101 patients underwent 12 months of endurance exercise combined with strength or balance training. BMD was assessed by dual-energy X-ray absorptiometry, and plasma intact PINP and TRAP5b were measured at baseline and study end.
RESULTS
Median intact PINP and TRAP5b remained largely unchanged. In adjusted analyses including clinical, medication-related, and CKD-MBD covariates, no consistent associations were observed between bone turnover markers and BMD. ΔBMD was not associated with changes in intact PINP or TRAP5b. In multivariate models, age was the only consistent predictor of osteoporotic status across time points, while associations with intact PINP and female sex were not stable after sensitivity analyses.
CONCLUSION
In this cohort of patients with CKD stages 3-5 participating in a 12-month exercise intervention, circulating bone turnover markers (intact PINP and TRAP5b) showed minimal temporal change over 12 months and were not consistently associated with BMD or osteoporotic status after adjustment for clinical, biochemical, and treatment-related factors. Age was the only consistent variable associated with osteoporotic status across all models.
V. Petrauskiene, Matthias Hellberg, Philippa Svensson et al.· JN. Journal of Nephrology (M...· 0 citations
It is suggested that younger patients undergoing hemodialysis with elevated PTH and ALP levels may benefit from a more intensive approach to the management of hyperparathyroidism and older and more frail patients with relatively low PTH levels may be more likely to exhibit low bone volume and turnover and could potentially benefit from therapies aimed at stimulating bone formation, such as anabolic agents.
Eduardo J. Duque, Lauren S. Lowe, C. Carbonara et al.· Archives of Osteoporosis· 0 citations
Background: Bone disease remains a major long-term complication after kidney transplantation. However, the relationship between circulating bone turnover markers (BTMs) and densitometric skeletal parameters in kidney transplant recipients (KTRs) remains incompletely understood. Methods: This single-center, cross-sectional comparative study included 50 stable adult KTRs and 56 non-transplanted individuals with dual-energy X-ray absorptiometry (DXA)-confirmed osteopenia or osteoporosis. Serum bone formation markers, bone-specific alkaline phosphatase (BALP) and procollagen type I N-terminal propeptide (P1NP), and bone resorption markers, β-C-terminal telopeptide of type I collagen (β-CTX) and tartrate-resistant acid phosphatase 5b (TRAP5b), were quantified by enzyme-linked immunosorbent assay (ELISA). Bone mineral density (BMD), Z-scores, and Fracture Risk Assessment Tool (FRAX) estimates were obtained by DXA. Between-group comparisons were adjusted for age, sex, body mass index (BMI) and postmenopausal status, with sensitivity analyses restricted to participants with low bone mass. An exploratory receiver operating characteristic (ROC) analysis was performed to assess the association of BTMs with KTR status. Results: KTRs showed lower DXA-derived Z-scores at the total hip, femoral neck and lumbar spine despite being younger. After adjustment for age, sex, BMI and postmenopausal status, KTRs had significantly higher BALP (adjusted Δ = 129.96 ng/mL, p < 0.001) and PTH, and lower eGFR and magnesium than the reference group, whereas unadjusted differences in P1NP and lumbar spine BMD did not persist; β-CTX and TRAP5b did not differ between groups. BALP remained significantly higher in KTRs across the low-bone-mass restricted and propensity-score overlap analyses. BTMs showed no significant correlations with DXA parameters in KTRs. In the exploratory ROC analysis of study-group status, BALP showed the strongest separation between KTRs and the reference group (AUC = 0.808, p < 0.001). Conclusions: Long-term KTRs exhibit a distinct bone remodeling profile characterized most consistently by elevated BALP, which remained significant after adjustment and showed the strongest separation regarding KTR status. The limited BTM–DXA associations require confirmation in longitudinal studies.
Nada Akad, Ș. Bîlha, G. Dodi et al.· Journal of Clinical Medicine· 0 citations
No routinely measured biomarker demonstrated clinical utility for identifying BMD trajectory in this cohort of Saudi dual-energy X-ray absorptiometry patients, suggesting future studies with explicit treatment tracking and repeated bone-turnover measurements are required for confirmation.
L. Jambi, S. Kabrah· Journal of Clinical Medicine· 0 citations
BACKGROUND
We aimed to evaluate longitudinal changes in bone health over 4 years, examine differences based on diabetes duration, and identify predictors of skeletal outcomes in children and adolescents with T1DM.
METHODS
A single-centre, retrospective, longitudinal observational study was conducted at tertiary care centre in Western Maharashtra, India (December 2015-December 2022). Longitudinal data of children and adolescents from Sweetlings cohort on anthropometry, body composition, biochemical parameters, and bone health (DXA, pQCT) were extracted.
RESULTS
A total of 200 participants (mean age:10.6 ± 3.9 years; diabetes duration:3.2 ± 3.2 years) were followed for 4 years. Glycaemic control worsened over time, with increased insulin requirement and HbA1c, along with reduced insulin sensitivity. Decline in TBLH aBMD Z-scores (-1.4 ± 1.1 to -1.7 ± 1.2) was observed. Significant reductions in trabecular vBMD (167.7 ± 35.6 to 150.2 ± 39.8 mg/cm3), trabecular density-for-age Z-scores (-0.9 ± 1.5 to -1.7 ± 1.2), and total density-for-age Z-scores (-0.5 ± 1.5 to -1.0 ± 1.0), along with decline in cortical thickness, despite increase in cortical vBMD were reported. Participants with diabetes duration ≥5 years had lower insulin sensitivity, lean body mass, and bone parameters at baseline and follow-up, and experienced greater declines in trabecular and total volumetric BMD. Sex, pubertal status, glycaemic control, disease duration, and dyslipidemia were significant predictors of skeletal outcomes.
CONCLUSION
Children and adolescents with T1DM demonstrate progressive deterioration in bone health over time, particularly those with longer disease duration and adverse metabolic profiles. The discordance between bone density and geometry suggests that alterations in skeletal structure may not be fully reflected by areal bone density measurements alone. Early identification of high-risk individuals and longitudinal monitoring may help preserve bone health.
Shruti A. Mondkar, Madhura Karuggipkar, Mugdha Deshpande et al.· Bone· 0 citations
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