Bone histomorphometry and indicators of bone and mineral metabolism in wait-listed dialysis patients

Clin Nephrol. 2016 Mar;85(3):127-34. doi: 10.5414/CN108709.


Aims: The aim of this study was to evaluate the associations between bone histomorphometry and bone volume measured by dual-energy X-ray absorptiometry (DXA) in wait-listed dialysis patients. Further, the circulating markers of mineral metabolism and bone turnover were compared.

Material and methods: Bone biopsies were performed on 61 wait-listed dialysis patients. Plasma samples were obtained for indicators of mineral metabolism and bone turnover. Bone mineral density (BMD) was determined by DXA and bone histomorphometry was performed.

Results: Bone histomorphometry could be determined in 52 patients (72% men, 54% on hemodialysis and median dialysis vintage 18 months). Adynamic bone disease was present in 21% of patients and 4% had osteomalacia. High turnover bone disease (mixed uremic osteodystrophy and osteitis fibrosa) was observed in 48% of patients (17% and 31%, respectively). 10% of patients had normal bone histomorphometry while 17% had mild osteitis fibrosa. Mineralization defect was found in 33% of patients. There was a strong correlation between femoral neck (FN) T-score and histologically measured cancellous bone volume (p = 0.004), FN T-score having a good negative predictive value for low cancellous bone volume. Plasma osteocalcin levels were significantly higher in the high-turnover group and lower in the mineralization defect group (p = 0.014 and p = 0.02, respectively).

Conclusions: Our study confirms the high frequency of abnormal bone histology in wait-listed dialysis patients. Low bone turnover was less common than previously reported. Noninvasive markers had a limited value for assessing bone histology, whereas femoral BMD reflected bone volume well.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Alkaline Phosphatase / blood
  • Biomarkers / blood
  • Biopsy / methods
  • Bone Density / physiology
  • Bone Diseases, Metabolic
  • Bone Remodeling / physiology
  • Bone and Bones / metabolism
  • Bone and Bones / pathology*
  • Calcification, Physiologic / physiology
  • Chronic Kidney Disease-Mineral and Bone Disorder / diagnosis
  • Female
  • Femur / pathology
  • Humans
  • Male
  • Middle Aged
  • Minerals / metabolism
  • Osteitis Fibrosa Cystica / diagnosis
  • Osteocalcin / blood
  • Osteomalacia / diagnosis
  • Parathyroid Hormone / blood
  • Renal Dialysis*
  • Waiting Lists


  • Biomarkers
  • Minerals
  • Parathyroid Hormone
  • Osteocalcin
  • Alkaline Phosphatase