title: Differences in bone quality in low- and high-turnover renal osteodystrophy.
abstract: Abnormal bone turnover is common in CKD, but its effects on bone quality remain unclear. We qualitatively screened iliac crest bone specimens from patients on dialysis to identify those patients with low (n=18) or high (n=17) bone turnover. In addition, we obtained control bone specimens from 12 healthy volunteers with normal kidney function. In the patient and control specimens, Fourier transform infrared spectroscopy and nanoindentation quantified the material and mechanical properties of the specimens, and we used bone histomorphometry to assess parameters of bone microstructure and bone formation and resorption. Compared with high or normal turnover, bone with low turnover had microstructural abnormalities such as lower cancellous bone volume and reduced trabecular thickness. Compared with normal or low turnover, bone with high turnover had material and nanomechanical abnormalities such as reduced mineral to matrix ratio and lower stiffness. These data suggest that turnover-related alterations in bone quality may contribute to the diminished mechanical competence of bone in CKD, albeit through different mechanisms. Therapies tailored specifically to low- or high-turnover bone may treat renal osteodystrophy more effectively.
authors.affiliation: Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Albert B. Chandler Medical Center, Lexington, KY 40536-0298, USA. hhmall@uky.edu
authors.forename: Hartmut H
authors.initials: HH
authors.lastname: Malluche
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Porter
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Monier-Faugere
authors.forename: Hanna
authors.initials: H
authors.lastname: Mawad
authors.forename: David
authors.initials: D
authors.lastname: Pienkowski
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D001706:Biopsy; D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism* / Q000473:pathology; D016022:Case-Control Studies; D002908:Chronic Disease; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology* / Q000378:metabolism*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D006435:Renal Dialysis; D012720:Severity of Illness Index; D017550:Spectroscopy, Fourier Transform Infrared