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Mineral metabolism and cortical volumetric bone mineral density in childhood chronic kidney disease

Journal of Clinical Endocrinology and Metabolism, ISSN: 0021-972X, Vol: 98, Issue: 5, Page: 1930-1938
2013
  • 82
    Citations
  • 0
    Usage
  • 64
    Captures
  • 0
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    82
    • Citation Indexes
      78
    • Policy Citations
      3
      • Policy Citation
        3
    • Clinical Citations
      1
      • PubMed Guidelines
        1
  • Captures
    64

Article Description

Context: The relationships among cortical volumetric bone mineral density (CortBMD) and comprehensive measures of mineral metabolism have not been addressed in chronic kidney disease (CKD). Objective: The aim of the study was to identify the determinants of CortBMD in childhood CKD. A secondary objective was to assess whether CortBMD was associated with subsequent fracture. Design and Participants: This prospective cohort study included 171 children, adolescents, and young adults (aged 5-21 years) with CKD stages 2-5D at enrollment and 89 1 year later. Outcomes: Serum measures included vitamin D [25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D (1,25(OH)D), 24,25-dihydroxy vitamin D], vitamin D-binding protein, intact PTH, fibroblast growth factor 23, calcium, and phosphorus. Tibia quantitative computed tomography measures of CortBMD were expressed as sex-, race-, and age-specific Z-scores based on 675 controls. Multivariable linear regression identified the independent correlates of CortBMD Z-scores and the change in CortBMD Z-scores. Results: Lower calcium (β=.31/1 mg/dL, P=.01) and 25(OH)D (β=.18/10 ng/mL, P=.04) and higher PTH (β = -.02/10%, P = .002) and 1,25(OH) D (β = -.07/10%, P < .001) were independently associated with lower CortBMD Z-scores at baseline. The correlations of total, free, and bioavailable 25(OH)D with CortBMD did not differ. Higher baseline 1,25(OH) D (P < .05) and greater increases in PTH (P < .001) were associated with greater declines in CortBMD Z-scores. Greater increases in calcium concentrations were associated with greater increases in CortBMD Z-scores in growing children (interaction P = .009). The hazard ratio for fracture was 1.75 (95% confidence interval 1.15-2.67; P = .009) per SD lower baseline CortBMD. Conclusions: Greater PTH and 1,25(OH)D and lower calcium concentrations were independently associated with baseline and progressive cortical deficits in childhood CKD. Lower CortBMD Z-score was associated with increased fracture risk. Copyright © 2013 by The Endocrine Society.

Bibliographic Details

Denburg, Michelle R; Tsampalieros, Anne K; de Boer, Ian H; Shults, Justine; Kalkwarf, Heidi J; Zemel, Babette S; Foerster, Debbie; Stokes, David; Leonard, Mary B

The Endocrine Society

Medicine; Biochemistry, Genetics and Molecular Biology

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