Micropetrosis in hemodialysis patients

Aiji Yajima; Ken Tsuchiya; David B Burr; Taro Murata; Masaki Nakamura; Masaaki Inaba; Yoshihiro Tominaga; Tatsuhiko Tanizawa; Takashi Nakayama; Akemi Ito; Kosaku Nitta

doi:10.1016/j.bonr.2021.101150

Micropetrosis in hemodialysis patients

Bone Rep. 2021 Nov 27:15:101150. doi: 10.1016/j.bonr.2021.101150. eCollection 2021 Dec.

Authors

Aiji Yajima^{1

2

3}, Ken Tsuchiya³, David B Burr¹, Taro Murata², Masaki Nakamura⁴, Masaaki Inaba⁵, Yoshihiro Tominaga⁶, Tatsuhiko Tanizawa⁷, Takashi Nakayama⁸, Akemi Ito⁹, Kosaku Nitta¹⁰

Affiliations

¹ Department of Anatomy, Cell Biology and Physiology, Indiana University, School of Medicine, Indianapolis, IN, USA.
² Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
³ Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
⁴ Department of Nephrology and Urology, NTT East Kanto Hospital, Tokyo, Japan.
⁵ Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
⁶ Department of Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
⁷ Department of Orthopedic Surgery, Tanizawa Clinic, Niigata, Japan.
⁸ Department of Orthopedic Surgery, Towa Hospital, Tokyo, Japan.
⁹ Ito Bone Histomorphometry Institute, Niigata, Japan.
¹⁰ Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.

Abstract

Micropetrosis develops as a result of stagnation of calcium, phosphorus and bone fluid, which appears as highly mineralized bone area in the osteocytic perilacunar/canalicular system regardless of bone turnover of the patients. And microcracks are predisposed to increase in these areas, which leads to increased bone fragility. However, micropetrosis of hemodialysis (HD) patients has not been discussed at all. Micropetrosis area per bone area (Mp.Ar/B·Ar) and osteocyte number per micropetrosis area (Ot.N/Mp.Ar) were measured in nine HD patients with renal hyperparathyroidism (Group I), twelve patients with hypoparathyroidism within 1 year after the treatment of renal hyperparathyroidism (Group II) and seven patients suffering from hypoparathyroidism for over two years (Group III). And bone mineral density (BMD) and tissue mineral density (TMD) were calculated using μCT to evaluate bone mineral content of iliac bone of the patients. These parameters were compared among the three groups. Only Mp.Ar/B·Ar was statistically greater in Group II and III compared to Group I in the parameters of bone mineral content and micropetrosis. However, the other parameters were not statistically different among the three groups. In long-term HD patients, BMD and TMD may be modified by the causes of renal insufficiency and the treatment of renal bone disease. We concluded that Mp.Ar/B·Ar was greater in patients with long-term hypoparathyroidism than both those with short-term hypoparathyroidism and with renal hyperparathyroidism. Special attention should be paid to avoid long-term hypoparathyroidism of the patients from the view point of increased fracture risk caused by increased micropetrosis area.

Keywords: Bone histomorphometry; Fracture risk; Hemodialysis patients; Micropetrosis; μCT.