Association of bone mineral density with biochemical markers of bone turnover in hemodialysis children

Abstract

Implication for health policy/practice/research/medical education: In a study on 27 patients with chronic kidney disease (CKD), with the age of 14.9 ± 4.5 years, we found, positive correlations of parathyroid hormone (PTH) with total body, lumbar spine and femoral neck Z-score. In addition, a positive correlation between calcium and total body, lumbar spine and femoral neck Z-score was found. Interestingly, positive correlations between alkaline phosphatase (ALP) and lumbar spine Z-score was found too, while the correlation of this parameter with total body and femoral neck Z-score was not significant. In our study a majority of patients with CKD had low level of bone mineral density (BMD). In addition, lower levels of calcium (Ca), phosphorus (P) PTH, 25 (OH) vitamins D were found in patient with abnormal BMD Z-scores. Introduction: Although some descriptive and cross-sectional studies have been reported about bone mass in chronic kidney disease (CKD) children, only a few studies investigated markers of bone turnover and the bone mass measurements. Objectives: The aim of this study was to evaluate the association between bone mineral density (BMD) and biochemical markers of bone turnover in hemodialysis (HD) children. Patients and Methods: The children who had received dialysis for at least the preceding 6‐ month were included. BMD was measured for total body, the lumbar spine and the femoral neck and the blood samples were tested to assess biochemical bone turnover markers. Results: The study group was comprised of 27 patients with CKD, 9 males (33%) and 18 females (67%) with the mean ± SD age of the subjects 14.9 ± 4.5 years. Positive significant correlations of parathyroid hormone (PTH) with total body bone densitometry Z-score, lumbar spine and femoral neck Z-score(r = 0.43, P = 0.06; r = 0.41, P = 0.08 and r = 0.45, P = 0.05, respectively) was noted. In addition, positive significant correlations calcium and total body, lumbar spine and femoral neck Z-score (r = 0.52, P = 0.02; r = 0.28, P = 0.23 and r = 0.36, P = 0.12, respectively) was seen. Interestingly, a positive significant correlation between alkaline phosphatase (ALP) and lumbar spine Z-score was found (r = 0.46, P = 0.04), while the correlation of this parameter with total body and femoral neck Z-score was not significant (P > 0.05). Conclusion: In our study, majority of patients with CKD had low level of BMD. In addition, lower levels of calcium (Ca), phosphorus (P), PTH and 25 (OH) vitamins D in patients with abnormal BMD Z-scores were detected.