Low Turnover Renal Osteodystrophy With Abnormal Bone Quality and Vascular Calcification in Patients With Mild-to-Moderate CKD

Amr El-Husseini, Mohamed Abdalbary, Florence Lima, Mohamed Issa, Mohamed Tarek Ahmed, Michael Winkler, Habib Srour, Daniel Davenport, Guodong Wang, Marie Claude Faugere, Hartmut H. Malluche

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Introduction: Limited information is available on renal osteodystrophy (ROD) and vascular calcification (VC) during early chronic kidney disease (CKD). This study was designed to evaluate ROD and VC in 32 patients with CKD stages II to IV. Methods: Patients underwent dual-energy X-ray absorptiometry (DXA) for assessment of bone mineral density (BMD) and trabecular bone score (TBS), thoracic computed tomography for VC scoring using the Agatston method, and anterior iliac crest bone biopsy for mineralized bone histology, histomorphometry, and Fourier transform infrared spectroscopy (FTIR). Classical and novel bone markers were determined in the blood. Results: Mean estimated glomerular filtration rate (eGFR) was 44 ± 16 ml/min per 1.73 m2. Of the patients, 84% had low bone turnover. In Whites, eGFR correlated negatively with the turnover parameter activation frequency (Ac.f) (r −0.48, P = 0.019) and with parameters of bone formation. Most patients had VC (>80%) which correlated positively with levels of phosphorus, c-terminal fibroblast growth factor-23, and activin. Aortic calcifications (ACs) correlated negatively with bone formation rate (BFR) and Ac.f (rho −0.62, −0.61, P < 0.001). TBS correlated negatively with coronary calcification (rho −0.42, P = 0.019) and AC (rho −0.57, P = 0.001). These relationships remained after adjustment of age. The mineral-to-matrix ratio, an FTIR metric reflecting bone quality, was negatively related to Ac.f and positively related to AC. Conclusion: Low bone turnover and VC are predominant in early stages of CKD. This is the first study demonstrating mineral abnormalities indicating reduced bone quality in these stages of CKD.

Original languageEnglish
Pages (from-to)1016-1026
Number of pages11
JournalKidney International Reports
Issue number5
StatePublished - May 2022

Bibliographical note

Funding Information:
Support for the study was provided by the National Institutes of Health , grant 5RO1 DK 080770 , and the Kentucky Nephrology Research Trust.

Publisher Copyright:
© 2022 International Society of Nephrology


  • DXA
  • bone biopsy
  • bone quality
  • cardiovascular calcification
  • renal osteodystrophy
  • trabecular bone score

ASJC Scopus subject areas

  • Nephrology


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