Association of serum alkaline phosphatase and bone mineral density in maintenance hemodialysis patients

Jong Chan Park, Csaba Kovesdy, Uyen Duong, Elani Streja, Mehdi Rambod, Allen R. Nissenson, Stuart M. Sprague, Kamyar Kalantar-Zadeh

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Abstract

Recent studies indicate that serum alkaline phosphatase (AlkPhos), a surrogate of high turnover bone disease, is associated with coronary artery calcification and death risk in maintenance hemodialysis (MHD) patients. The association between AlkPhos and bone mineral density (BMD) is not well studied. We studied the association between AlkPhos and dual-energy X-ray absorptiometry-assessed BMD in a group of MHD patients in Southern California. In 154 MHD patients, aged 55.3 ± 13.6 years, including 42% women, 38% Hispanics, 42% African Americans, and 55% diabetics, the mean serum AlkPhos was 121 ± 63 U/L (median: 101, Q25-75: 81-141); 36% had AlkPhos≥120 U/L and 50% had a total T-score≤-1. Whereas the total BMD did not correlate with age (r=0.01, P=0.99) or body mass index (r=0.10, P=0.22), it correlated negatively with AlkPhos (r=-0.25, P=0.002), including after multivariate adjustment (r=-0.24, P=0.003). The proportion of patients with a high coronary artery calcification score>400 was incrementally higher across worsening BMD tertiles (P trend=0.04). The BMD was significantly worse in MHD patients with serum AlkPhos≥120 U/L compared with <120 U/L (1.01 ± 0.016 vs. 1.08 ± 0.013 g/cm2, respectively, P<0.001). The multivariate adjusted odds ratio of AlkPhos≥120 U/L for having a total T-score<-1.0 was 2.3 (1.1-4.8, P=0.037). Among routine clinical and biochemical markers, serum AlkPhos≥120 U/L was a better predictor of total T-score≤-1 in MHD patients. An association exists between higher serum AlkPhos and worse dual-energy X-ray absorptiometry-assessed BMD in MHD patients. Given these findings, studies are indicated to examine whether interventions that lower serum AlkPhos improve BMD in MHD patients.

Original languageEnglish (US)
Pages (from-to)182-192
Number of pages11
JournalHemodialysis International
Volume14
Issue number2
DOIs
StatePublished - Apr 1 2010
Externally publishedYes

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Bone Density
Alkaline Phosphatase
Renal Dialysis
Maintenance
Serum
Photon Absorptiometry
Coronary Vessels
Biomarkers
Bone Diseases
Hispanic Americans
African Americans
Body Mass Index
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Hematology
  • Nephrology

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Association of serum alkaline phosphatase and bone mineral density in maintenance hemodialysis patients. / Park, Jong Chan; Kovesdy, Csaba; Duong, Uyen; Streja, Elani; Rambod, Mehdi; Nissenson, Allen R.; Sprague, Stuart M.; Kalantar-Zadeh, Kamyar.

In: Hemodialysis International, Vol. 14, No. 2, 01.04.2010, p. 182-192.

Research output: Contribution to journalArticle

Park, JC, Kovesdy, C, Duong, U, Streja, E, Rambod, M, Nissenson, AR, Sprague, SM & Kalantar-Zadeh, K 2010, 'Association of serum alkaline phosphatase and bone mineral density in maintenance hemodialysis patients', Hemodialysis International, vol. 14, no. 2, pp. 182-192. https://doi.org/10.1111/j.1542-4758.2009.00430.x
Park, Jong Chan ; Kovesdy, Csaba ; Duong, Uyen ; Streja, Elani ; Rambod, Mehdi ; Nissenson, Allen R. ; Sprague, Stuart M. ; Kalantar-Zadeh, Kamyar. / Association of serum alkaline phosphatase and bone mineral density in maintenance hemodialysis patients. In: Hemodialysis International. 2010 ; Vol. 14, No. 2. pp. 182-192.
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abstract = "Recent studies indicate that serum alkaline phosphatase (AlkPhos), a surrogate of high turnover bone disease, is associated with coronary artery calcification and death risk in maintenance hemodialysis (MHD) patients. The association between AlkPhos and bone mineral density (BMD) is not well studied. We studied the association between AlkPhos and dual-energy X-ray absorptiometry-assessed BMD in a group of MHD patients in Southern California. In 154 MHD patients, aged 55.3 ± 13.6 years, including 42{\%} women, 38{\%} Hispanics, 42{\%} African Americans, and 55{\%} diabetics, the mean serum AlkPhos was 121 ± 63 U/L (median: 101, Q25-75: 81-141); 36{\%} had AlkPhos≥120 U/L and 50{\%} had a total T-score≤-1. Whereas the total BMD did not correlate with age (r=0.01, P=0.99) or body mass index (r=0.10, P=0.22), it correlated negatively with AlkPhos (r=-0.25, P=0.002), including after multivariate adjustment (r=-0.24, P=0.003). The proportion of patients with a high coronary artery calcification score>400 was incrementally higher across worsening BMD tertiles (P trend=0.04). The BMD was significantly worse in MHD patients with serum AlkPhos≥120 U/L compared with <120 U/L (1.01 ± 0.016 vs. 1.08 ± 0.013 g/cm2, respectively, P<0.001). The multivariate adjusted odds ratio of AlkPhos≥120 U/L for having a total T-score<-1.0 was 2.3 (1.1-4.8, P=0.037). Among routine clinical and biochemical markers, serum AlkPhos≥120 U/L was a better predictor of total T-score≤-1 in MHD patients. An association exists between higher serum AlkPhos and worse dual-energy X-ray absorptiometry-assessed BMD in MHD patients. Given these findings, studies are indicated to examine whether interventions that lower serum AlkPhos improve BMD in MHD patients.",
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