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Aeimlapa R, Wongdee K, Tiyasatkulkovit W, Kengkoom K, Krishnamra N, Charoenphandhu N. Anomalous bone changes in ovariectomized type 2 diabetic rats: inappropriately low bone turnover with bone loss in an estrogen-deficient condition. Am J Physiol Endocrinol Metab 2019; 317:E646-E657. [PMID: 31361547 DOI: 10.1152/ajpendo.00093.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Estrogen deprivation accelerates bone resorption, leading to imbalance of bone remodeling and osteoporosis in postmenopausal women. In the elderly, type 2 diabetes mellitus (T2DM) frequently coexists as an independent factor of bone loss. However, little is known about the skeletal changes in a combined condition of estrogen deficiency and T2DM. Herein, we performed ovariectomy (OVX) in nonobese Goto-Kakizaki (GK) T2DM rats to examine changes associated with calcium and phosphate metabolism and bone microstructures and strength. As expected, wild-type (WT) rats subjected to ovariectomy (OVX-WT) had low trabecular bone volume and serum calcium with increased dynamic histomorphometric and serum bone markers, consistent with the high turnover state. T2DM in GK rats also led to low trabecular volume and serum calcium. However, the dynamic histomorphometric markers of bone remodeling were unaffected in these GK rats, indicating the distinct mechanism of T2DM-induced bone loss. Interestingly, OVX-GK rats were found to have anomalous and unique changes in bone turnover-related parameters, i.e., decreased osteoblast and osteoclast surfaces with lower COOH-terminal telopeptide of type I collagen levels compared with OVX-WT rats. Furthermore, the levels of calciotropic hormones, i.e., parathyroid hormone and 1,25(OH)2D3, were significantly decreased in OVX-GK rats. Although the OVX-induced bone loss did not further worsen in GK rats, a three-point bending test indicated that OVX-GK bones exhibited a decrease in bone elasticity. In conclusion, T2DM and estrogen deficiency both led to microstructural bone loss, the appearance of which did not differ from each factor alone. Nevertheless, the combination worsened the integrity and suppressed the turnover, which might eventually result in adynamic bone disease.
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Affiliation(s)
- Ratchaneevan Aeimlapa
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Kannikar Wongdee
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Wacharaporn Tiyasatkulkovit
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
- Department of Biology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Kanchana Kengkoom
- National Laboratory Animal Center, Mahidol University, Nakhon Pathom, Thailand
| | - Nateetip Krishnamra
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Narattaphol Charoenphandhu
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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de Oliveira RA, Barreto FC, Mendes M, dos Reis LM, Castro JH, Britto ZML, Marques IDB, Carvalho AB, Moysés RM, Jorgetti V. Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease. Kidney Int 2014; 87:1039-45. [PMID: 25493951 DOI: 10.1038/ki.2014.372] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 08/30/2014] [Accepted: 09/18/2014] [Indexed: 11/09/2022]
Abstract
Chronic kidney disease--mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins, and dialysis modality. Although extensively studied in hemodialysis (HD) patients, only a few studies exist for peritoneal dialysis (PD) patients. Since most of these older studies contain no bone biopsy data, we studied the pattern of renal osteodystrophy in 41 prevalent PD patients. The most common presentation was adynamic bone disease (49%). There was a significant inverse association between serum sclerostin (a Wnt/β-catenin pathway inhibitor that decreases osteoblast action and bone formation) and the bone formation rate. Bone alkaline phosphatase had the best sensitivity and specificity to detect both high- and low-turnover diseases. The comparison between nondiabetic PD and HD patients, matched by age, gender, parathyroid hormone level, and length of dialysis, revealed low 25-hydroxyvitamin D levels, worse bone mineralization, and low bone turnover in the nondiabetic PD group. Thus, adynamic bone disease was the most frequent type of renal osteodystrophy in PD patients. Sclerostin seems to participate in the pathophysiology of adynamic bone disease and bone alkaline phosphatase was the best serum marker of bone turnover in these patients.
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Affiliation(s)
- Rodrigo A de Oliveira
- 1] Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil [2] Department of Integrated Medicine, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Fellype C Barreto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Monique Mendes
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Luciene M dos Reis
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - João Henrique Castro
- Department of Internal Medicine, Nephrology Division, Universidade Estadual Paulista, Botucatu, Brazil
| | - Zita Maria L Britto
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Igor D B Marques
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Aluizio B Carvalho
- Department of Internal Medicine, Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rosa M Moysés
- 1] Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil [2] Medicine Master Degree Program, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Vanda Jorgetti
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
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Ferreira JC, Ferrari GO, Neves KR, Cavallari RT, Dominguez WV, dos Reis LM, Graciolli FG, Oliveira EC, Liu S, Sabbagh Y, Jorgetti V, Schiavi S, Moysés RMA. Effects of dietary phosphate on adynamic bone disease in rats with chronic kidney disease--role of sclerostin? PLoS One 2013; 8:e79721. [PMID: 24236156 PMCID: PMC3827459 DOI: 10.1371/journal.pone.0079721] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/04/2013] [Indexed: 02/01/2023] Open
Abstract
High phosphate intake is known to aggravate renal osteodystrophy along various pathogenetic pathways. Recent studies have raised the possibility that dysregulation of the osteocyte Wnt/β-catenin signaling pathway is also involved in chronic kidney disease (CKD)-related bone disease. We investigated the role of dietary phosphate and its possible interaction with this pathway in an experimental model of adynamic bone disease (ABD) in association with CKD and hypoparathyroidism. Partial nephrectomy (Nx) and total parathyroidectomy (PTx) were performed in male Wistar rats. Control rats with normal kidney and parathyroid function underwent sham operations. Rats were divided into three groups and underwent pair-feeding for 8 weeks with diets containing either 0.6% or 1.2% phosphate: sham 0.6%, Nx+PTx 0.6%, and Nx+PTx 1.2%. In the two Nx+PTx groups, serum creatinine increased and blood ionized calcium decreased compared with sham control group. They also presented hyperphosphatemia and reduced serum parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) levels. Fractional urinary excretion of phosphate increased in Nx+PTx 1.2% rats despite lower PTH and FGF23 levels than in sham group. These biochemical changes were accompanied by a decrease in bone formation rates. The Nx+PTx 1.2% group had lower bone volume (BV/TV), higher osteoblast and osteocyte apoptosis, and higher SOST and Dickkopf-1 gene expression than the Nx+PTx 0.6% group. Nx+PTx 0.6% rat had very low serum sclerostin levels, and Nx+PTx 1.2% had intermediate sclerostin levels compared with sham group. Finally, there was a negative correlation between BV/TV and serum sclerostin. These results suggest that high dietary phosphate intake decreases bone volume in an experimental model of CKD-ABD, possibly via changes in SOST expression through a PTH-independent mechanism. These findings could have relevance for the clinical setting of CKD-ABD in patients who low turnover bone disease might be attenuated by optimal control of phosphate intake and/or absorption.
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Affiliation(s)
- Juliana C. Ferreira
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Guaraciaba O. Ferrari
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Katia R. Neves
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Raquel T. Cavallari
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Wagner V. Dominguez
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Luciene M. dos Reis
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Fabiana G. Graciolli
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Elizabeth C. Oliveira
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Shiguang Liu
- The Sanofi-Genzyme R&D Center, Genzyme Corporation, Framingham, Massachusetts, United States of America
| | - Yves Sabbagh
- The Sanofi-Genzyme R&D Center, Genzyme Corporation, Framingham, Massachusetts, United States of America
| | - Vanda Jorgetti
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
| | - Susan Schiavi
- The Sanofi-Genzyme R&D Center, Genzyme Corporation, Framingham, Massachusetts, United States of America
| | - Rosa M. A. Moysés
- Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil
- * E-mail:
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Christoforidis A, Printza N, Gkogka C, Siomou E, Challa A, Kazantzidou E, Kollios K, Papachristou F. Comparative study of quantitative ultrasonography and dual-energy X-ray absorptiometry for evaluating renal osteodystrophy in children with chronic kidney disease. J Bone Miner Metab 2011; 29:321-7. [PMID: 20845051 DOI: 10.1007/s00774-010-0220-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
Abstract
Our aim was to assess bone parameters in children with chronic kidney disease (CKD) with both dual-energy X-ray absorptiometry (DXA) and quantitative ultrasonography (QUS) and additionally with biochemical markers of bone turnover. Twenty children (12 boys and 8 girls) with CKD and a mean decimal age of 9.47 ± 4.44 years were included in the study where anthropometric parameters (height and weight), pubertal status, bone mineral density (BMD) at lumbar spine, speed of sound (SOS) measured by QUS at radius and at tibia, and biochemical markers of bone metabolism were measured. Six patients (30%) had tibial SOS Z score <-1, and 52.7% had radial SOS Z score <-1, whereas only 16.67% had BMD Z score <-1. Patients had significantly increased levels of serum intact parathormone (p < 0.001), serum bone alkaline phosphatase (BAP) (p < 0.001) and serum N-terminal-mid fragment (aminoacids 1-43) of osteocalcin (p < 0.001) compared to controls, whereas serum osteoprotegerin was significantly decreased in patients compared to controls (p = 0.001). SOS was significantly correlated to BAP (r = -0.586, p = 0.013 and r = -0.709, p = 0.001, respectively, for radius and tibia). In conclusion no association between DXA and QUS measurements was documented in our study, whereas QUS was better correlated to biochemical indices of ROD.
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Affiliation(s)
- Athanasios Christoforidis
- 1st Paediatric Department, Aristotle University, 49, Konstantinoupoleos str., 54642 Thessaloniki, Greece.
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Feroze U, Molnar MZ, Dukkipati R, Kovesdy CP, Kalantar-Zadeh K. Insights into nutritional and inflammatory aspects of low parathyroid hormone in dialysis patients. J Ren Nutr 2011; 21:100-4. [PMID: 21195929 PMCID: PMC3032422 DOI: 10.1053/j.jrn.2010.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In individuals with advanced chronic kidney disease, secondary hyperparathyroidism is known to be associated with high turnover bone disease. Low serum parathyroid hormone (PTH) levels may not necessarily be because of hypodynamic bone, but could be another facet of the malnutrition-inflammation-cachexia syndrome (MICS). A recent 5-year cohort study in 748 stable hemodialysis outpatients showed that after the confounding effect by the MICS was removed, the moderately low levels of PTH in the 100 to 150 pg/mL range was associated with the greatest survival rate. Data from Japanese dialysis patients show similar survival advantages of having a lower PTH range. Low levels of serum PTH seem to be associated with markers of protein-energy wasting and inflammation, and this association may confound the relationship between serum PTH and alkaline phosphatase. PTH stimulates lipogenesis through influx of calcium into the adipocytes. PTH secretion is suppressed by interleukin-1 beta and interleukin-6, which are proinflammatory cytokines that are associated with poor outcome in dialysis patients. These cytokines inhibits PTH secretion in cultured parathyroid tissue slices. In this article, we review the association of a low serum PTH level with the MICS in patients with chronic kidney disease and suggest avoiding over-interpretation of low serum PTH level as an indicator of low turnover bone disease.
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Affiliation(s)
- Usama Feroze
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502
| | - Miklos Z Molnar
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502
| | - Ramanath Dukkipati
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502
- Division of Nephrology & Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502
| | | | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502
- Division of Nephrology & Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502
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Dukkipati R, Kovesdy CP, Kim Y, Colman S, Budoff MJ, Nissenson AR, Sprague SM, Kopple JD, Kalantar-Zadeh K. Association of relatively low serum parathyroid hormone with malnutrition-inflammation complex and survival in maintenance hemodialysis patients. J Ren Nutr 2010; 20:243-54. [PMID: 20199875 PMCID: PMC3175364 DOI: 10.1053/j.jrn.2009.10.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Low serum parathyroid hormone (PTH) has been implicated as a primary biochemical marker of adynamic bone disease in individuals with chronic kidney disease (CKD) who undergo maintenance hemodialysis (MHD) treatment. We hypothesized that the malnutrition-inflammation complex is associated with low PTH levels in these patients and confounds the PTH-survival association. METHODS We examined 748 stable MHD outpatients in southern California and followed them for up to 5 years (October 2001-December 2006). RESULTS In 748 MHD patients, serum PTH <150pg/mL was more prevalent among non-blacks and diabetics. There was no association between serum PTH and coronary artery calcification score, bone mineral density, or dietary protein or calorie intake. Low serum PTH was associated with markers of protein-energy wasting and inflammation, and this association confounded the relationship between serum PTH and alkaline phosphatase. Although 5-year crude mortality rates were similar across PTH increments, after adjustment for the case-mix and surrogates of malnutrition and inflammation, a moderately low serum PTH in 100-150pg/mL range was associated with the greatest survival compared to other serum PTH levels, i.e., a death hazard ratio of 0.52 (95% confidence interval: 0.29-0.92, p<0.001) compared to PTH of 300-600pg/mL (reference). CONCLUSIONS Low serum PTH may be another facet of the malnutrition-inflammation complex in CKD, and after controlling for this confounder, a moderately low PTH in 100-150pg/mL range appears associated with the greatest survival. Limitations of observational studies should be considered.
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Affiliation(s)
- Ramanath Dukkipati
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, CA 90502
| | | | - Youngmee Kim
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, CA 90502
| | | | - Matthew J Budoff
- Division of Cardiology; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502
- David Geffen UCLA School of medicine, Los Angeles, CA
| | - Allen R. Nissenson
- David Geffen UCLA School of medicine, Los Angeles, CA
- DaVita, El Segundo, CA
| | - Stuart M. Sprague
- Northwestern University Feinberg School of Medicine, Evanston Northwestern Healthcare, Evanston, IL
| | - Joel D Kopple
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, CA 90502
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, CA 90502
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A different interaction between parathyroid hormone, calcitriol and serum aluminum in chronic kidney disease; a pilot study. Int Urol Nephrol 2010; 43:467-70. [DOI: 10.1007/s11255-010-9784-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
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Abstract
Severe refeeding hypophosphatemia has been reported in infants and adults on continuous ambulatory peritoneal dialysis. We report an episode of transient encephalopathy and cardiac suppression in a diabetic, malnourished end-stage renal disease patient undergoing peritoneal dialysis with a glucose-based solution, which was associated with severe hypophosphatemia. Further investigation revealed an adynamic bone disease. The potential factors precipitating this episode of hypophosphatemia are discussed.
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