Bone turnover markers are associated with bone density, but not with fracture in end stage kidney disease: a cross-sectional study

Hanne Skou Jørgensen, Simon Winther, Morten Bøttcher, Ellen-Margrethe Hauge, Lars Rejnmark, My Svensson, Per Ivarsen, Hanne Skou Jørgensen, Simon Winther, Morten Bøttcher, Ellen-Margrethe Hauge, Lars Rejnmark, My Svensson, Per Ivarsen

Abstract

Background: Fracture risk is increased in chronic kidney disease (CKD), but assessment of bone fragility remains controversial in these patients. This study investigated the associations between bone turnover markers, bone mineral density (BMD), and prevalent fragility fracture in a cohort of kidney transplantation candidates.

Methods: Volumetric BMD of spine and hip was measured by quantitative computed tomography. Parathyroid hormone (PTH), bone-specific alkaline phosphatase, procollagen type-1 N-terminal propeptide, tartrate resistant alkaline phosphatase, and C- and N-terminal telopeptides of type 1 collagen were analyzed from fasting morning blood samples. Fragility fractures included prevalent vertebral fractures and previous low-trauma clinical fractures.

Results: The fracture prevalence was 18% in 157 adult kidney transplant candidates. Fractured patients had reduced BMD and Z-score at both spine and hip. Levels of bone turnover markers were significantly higher in patients on maintenance dialysis than in pre-dialysis patients; but did not differ between patients with and without fracture. There were strong, positive correlations between PTH and all bone turnover markers. PTH was negatively associated with Z-score at lumbar spine and total hip; in contrast, bone turnover markers were only negatively associated with total hip Z-score.

Conclusions: Bone turnover markers were negatively associated with bone density, but not associated with prevalent fracture in kidney transplantation candidates. The role of bone turnover markers in assessing bone fragility in CKD will require further investigation.

Trial registration: This study was registered at ClinicalTrials.gov with identifier NCT01344434 .

Keywords: Bone density; Bone remodeling; Chronic kidney disease; Fracture; Osteoporosis; Renal osteodystrophy.

Conflict of interest statement

Ethics approval and consent to participate

All patients provided written informed consent prior to study participation. The study was approved by the Central Denmark Region Committee on Health Research Ethics and The Danish Data Protection Agency and followed the principles of the declaration of Helsinki. It was registered at Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Levels of bone turnover markers in kidney transplantation candidates by dialysis status. Boxplots with median and interquartile range, whiskers at 5 and 95%, p = Student’s t test
Fig. 2
Fig. 2
Z-scores of spine and hip in kidney transplantation candidates with and without diabetes mellitus. Data are mean with standard errors, ANOVA p = one-way analysis of variance, p = student’s t test
Fig. 3
Fig. 3
Bone density and Z-scores in kidney transplantation candidates with and without fragility fracture. Mean values with standard errors, p = Student’s t test

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