Low bone turnover is associated with plain X-ray vascular calcification in predialysis patients

• Published in: PloS one Vol. 16; no. 10; p. e0258284
• Main Authors: Neto, Ricardo, Pereira, Luciano, Magalhães, Juliana, Quelhas-Santos, Janete, Frazão, João
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.10.2021; Public Library of Science (PLoS)
• Subjects: Aged; Alfacalcidol; Antibiotics; Biology and Life Sciences; Biomedical engineering; Biomedical materials; Biopsy; Bisphosphonates; Bone and Bones - pathology; Bone growth; Bone histomorphometry; Bone Remodeling - physiology; Bone turnover; Calcifediol; Calcification; Calcification (ectopic); Cardiovascular diseases; Chronic kidney failure; Complications and side effects; Creatinine; Development and progression; Diabetes; Diabetes mellitus; Diagnosis; Dialysis; Dosage and administration; Engineering; Female; Health risks; Humans; Hypertension; Immunoassay; Infectious diseases; Kidney diseases; Male; Medical research; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Mineral metabolism; Mineralization; Morbidity; Mortality; Multivariate Analysis; Nephrology; Osteogenesis; Osteoprotegerin; Pelvis; Peptides; Phosphonates; Phosphorus; Portugal; Regression Analysis; Renal Dialysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnostic imaging; Renal Insufficiency, Chronic - physiopathology; Research and Analysis Methods; Risk analysis; Risk factors; Salts; SOST protein; Spine; Spine (lumbar); Steroid hormones; Testing; Variables; Vascular Calcification - complications; Vascular Calcification - diagnostic imaging; Vascular Calcification - physiopathology; Vitamin D; Vitamin deficiency; X-Rays; Portugal; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0258284

Vascular calcification (VC) is a common finding in chronic kidney disease (CKD) patients and predicts subsequent cardiovascular morbidity and mortality in this population. Vascular calcification is linked to disordered mineral metabolism and has been associated with bone histomorphometry changes in CKD. However, data on predialysis patients is scarce. A cross-sectional study was conducted on a cohort of 56 CKD patients not yet on dialysis, who underwent a transiliac bone biopsy for histomorphometric evaluation after double tetracycline labeling. Patients had no previous exposure to calcium salts, vitamin D agents, steroids or bisphosphonates. Vascular calcification was assessed at the time of biopsy, using Kauppila (plain X-ray of the lateral lumbar spine) and Adragão (plain X-ray of the pelvis and hands) scores. Vascular calcification was seen in two-thirds of the cohort. Subjects with VC were more likely to be male and have diabetes, and had significantly higher sclerostin and osteoprotegerin circulating levels than those without VC. The histomorphometric analysis showed that bone formation rate was significantly lower in VC compared to non-VC patients. In the multivariable logistic regression analysis, bone formation rate was independently associated with the presence of VC. Vascular calcification is highly prevalent in predialysis patients, especially in those with diabetes. The independent association between bone formation rate and VC provides evidence of an important interaction between bone and vessel in CKD. Our results suggest that low bone turnover is a non-traditional risk factor for cardiovascular disease in predialysis patients.