Serum BAP as the clinically useful marker for predicting BMD reduction in diabetic hemodialysis patients with low PTH.
With decrease of serum PTH in hemodialysis (HD) patients, other factors besides parathyroid hormone (PTH) become important in regulating bone metabolism. We investigated which serum bone metabolic marker is the best to predict the bone mineral density (BMD) reduction in HD patients with serum PTH<180 pg/ml. The bone formation markers, bone alkaline phosphatase (BAP), intact osteocalcin (OC), and N-terminal propeptide of type I collagen (PINP), and the bone resorption markers, deoxypyridinoline (DPD), pyridinoline (PYD), and beta-crossLaps (beta-CTx) were measured in serum from 137 HD patients. BMD of all patients was measured twice, approximately 1.5 years before and 1.5 years after measurement of their markers of bone metabolism. In all 137 HD patients, serum BAP was the only marker significantly higher in those with BMD reduction than in those without. In 42 diabetes mellitus (DM) HD patients with serum PTH<180 pg/ml, hypothetically low bone turnover state, serum BAP was again the only marker to discriminate those with BMD reduction from those without. At serum PTH<60 pg/ml, serum BAP retained tendency toward higher value. These findings suggest that serum BAP might be the most sensitive to identify small changes of bone metabolism in low bone turnover state. Retrospective study confirmed the usefulness of serum BAP in clinical practice by significantly higher values in those with bone loss at PTH<180 pg/ml even in under routine sample handling. In conclusion, serum BAP is a clinically useful bone formation marker to predict the BMD reduction in DM HD patients with low level of PTH.
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City, University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Misako
M
Ueda
Masaaki
M
Inaba
Senji
S
Okuno
Yoshifumi
Y
Maeno
Eiji
E
Ishimura
Tomoyuki
T
Yamakawa
Yoshiki
Y
Nishizawa
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D000596:Amino Acids / Q000097:blood; D015415:Biomarkers; D015519:Bone Density / Q000502:physiology*; D001846:Bone Development / Q000502:physiology; D001862:Bone Resorption / Q000097:blood; D001842:Bone and Bones / Q000201:enzymology*; D002118:Calcium / Q000378:metabolism; D003094:Collagen / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000097:blood / Q000201:enzymology* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood / Q000172:deficiency*; D010446:Peptide Fragments / Q000097:blood / Q000378:metabolism; D011347:Procollagen / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies
D000596:Amino Acids; D015415:Biomarkers; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D011347:Procollagen; C110762:glutamyl-lysyl-alanyl-histidyl-aspartyl-glycyl-glycyl-arginine; C047202:procollagen Type I N-terminal peptide; D015675:Osteocalcin; C015484:pyridinoline; C036020:deoxypyridinoline; D003094:Collagen; D000469:Alkaline Phosphatase; D002118:Calcium