High prevalence of low bone mineral density in pre-dialysis chronic kidney disease patients: bone histomorphometric analysis

Clin Nephrol. 2004 Dec;62(6):432-9. doi: 10.5414/cnp62432.


Chronic kidney disease (CKD) leads to reduced bone mineral density (BMD) in pre-dialysis and dialysis patients. A few studies have used dual-energy x-ray absorptiometry (DEXA) to assess BMD in pre-dialysis CKD patients and have shown low BMD to be highly prevalent. Until now there have been no studies reporting the histological features of low BMD in pre-dialysis CKD patients.

Aim: To determine the prevalence and histological features of low BMD in pre-dialysis CKD patients.

Method: Pre-dialysis CKD patients (n = 103, 46 females/57 males), median creatinine clearance of 29 (10 - 78) ml/min/ 1.73 m2, were evaluated using biochemical analysis and DEXA. Bone biopsies were obtained from those with low BMD.

Results: Fifty (48.5%) out of the 103 patients had low BMD (LBD group) and 53 (51.5%) had normal BMD (NBD group). The risk for low BMD was increased in those patients with alkaline phosphatase levels above 190 U/l and intact-PTH (iPTH) below 70 pg/ml (p < 0.05). Demographic and biochemical parameters from both groups were comparable, except for lower body mass index (BMI) in LBD subjects (p = 0.04). Women who had been post-menopausal for at least 1 year comprised 65% (13/20) and 50% (13/26) of the LBD and NBD groups, respectively (p = NS). In 40 LBD patients, bone histomorphometry revealed adynamic bone disease (ABD, 52.5%), osteomalacia (OM, 42.5%) and mixed bone disease (MBD, 5%). Trabecular bone volume (BV/TV) was lower in ABD and OM patients. A nearly significant association was found between ABD and iPTH < or = 150 pg/ml (p = 0.056), whereas higher values of iPTH were associated with OM. Total alkaline phosphatase < or = 190 U/l was significantly associated with ABD, whereas higher values were associated with OM. No correlation was observed between BV/TV and BMD.

Conclusion: Low BMD is frequent in pre-dialysis CKD patients, and low turnover bone disease, manifesting as ABD and OM, was the hallmark of this bone loss.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Aged
  • Alkaline Phosphatase / blood
  • Body Mass Index
  • Bone Density*
  • Bone Diseases / metabolism
  • Bone Diseases / pathology
  • Creatinine / metabolism
  • Female
  • Humans
  • Kidney / pathology*
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / pathology*
  • Male
  • Middle Aged
  • Osteomalacia / metabolism
  • Osteomalacia / pathology
  • Prevalence


  • Creatinine
  • Alkaline Phosphatase