Durairaj Arjunan, Soham Mukherjee, Sanjay K Bhadada, Jayaditya Ghosh, Ravi Shah, Subin S., Sadam Hussain, Rimesh Pal, GSRSNK Naidu, Pinaki Dutta
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引用次数: 0
Abstract
Summary
Adults with renal tubular acidosis (RTA) show high bone turnover, reduced trabecular volumetric bone mineral density (vBMD), and compromised bone microarchitecture, especially in trabecular bone. HR-pQCT analysis reveals lower total vBMD, reduced trabecular number, increased separation, and cortical thinning, highlighting bone deterioration in RTA patients compared to controls.
Background
Renal tubular acidosis (RTA) impairs urinary acidification, leading to a normal anion gap metabolic acidosis and often hypokalemia. RTA can result in poor bone mineralization and reduced bone density in adults. This study aims to evaluate bone microarchitecture in adults with RTA using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT).
Methods
In this cross-sectional case–control study, 12 adult RTA patients with rickets/osteomalacia and 12 age, sex, and BMI-matched controls were enrolled. Clinical assessments, biochemical tests with calcium, phosphate, alkaline phosphatase, 25(OH)D, intact PTH, bone turnover markers, dual-energy X-ray absorptiometry (DXA), and HR-pQCT scans were conducted.
Results
Patients with RTA had increased bone turnover compared to the controls. RTA patients had significantly lower total hip areal bone mineral density (aBMD) [g/cm2] (median, 0.792 vs. 0.943; p = 0.014) and lower distal radius aBMD [g/cm2] (median, 0.469 vs. 0.694, p 0.000), compared to controls. HR-pQCT findings suggest lower total and trabecular volumetric BMD (v.BMD), at both the radius (median total vBMD [mg HA/cm3]: 236 vs. 380.1, p = 0.001; median trabecular vBMD [mg HA/cm3]; 83.4 vs. 170.1, p = 0.000) and tibia (median total vBMD [mg HA/cm3]: 222.1 vs. 317.4, p = 0.000; median trabecular vBMD [mg HA/cm3]: 69.0 vs. 160.9, p = 0.000) in RTA patients compared to controls. Cortical vBMD was comparable between groups. Microarchitecture analysis revealed reduced trabecular number, increased trabecular separation, increased trabecular bone inhomogeneity, and reduced cortical thickness in RTA patients, both at radius and tibia.
Conclusion
Adults with RTA exhibit high bone turnover, reduced trabecular vBMD, and compromised bone microarchitecture, particularly in trabecular bone.
成人肾小管酸中毒（RTA）表现为高骨转换，小梁体积骨密度（vBMD）降低，骨微结构受损，尤其是小梁骨。HR-pQCT分析显示，与对照组相比，RTA患者的总vBMD较低，小梁数量减少，分离增加，皮质变薄，突出了骨退化。肾小管酸中毒（RTA）损害尿酸化，导致正常的阴离子间隙代谢性酸中毒和经常低钾血症。RTA可导致成人骨矿化不良和骨密度降低。本研究旨在利用第二代高分辨率外周定量计算机断层扫描（HR-pQCT）评估成人RTA患者的骨微结构。方法在这项横断面病例对照研究中，纳入了12名成年佝偻病/骨软化症RTA患者和12名年龄、性别和bmi匹配的对照组。进行临床评估、钙、磷酸盐、碱性磷酸酶、25(OH)D、完整甲状旁腺激素、骨转换标志物、双能x线吸收仪（DXA）和HR-pQCT扫描等生化试验。结果与对照组相比，RTA患者的骨转换增加。RTA患者的全髋面骨矿物质密度（aBMD） [g/cm2]显著降低(中位数，0.792 vs. 0.943；p = 0.014)和桡骨下远端aBMD [g/cm2]（中位数，0.469 vs. 0.694, p 0.000）。HR-pQCT结果显示桡骨和小梁体积骨密度（v.BMD）均较低(中位总骨密度[mg HA/cm3]: 236比380.1,p = 0.001；中小梁vBMD [mg HA/cm3]；83.4 vs. 170.1, p = 0.000)和胫骨(中位总vBMD [mg HA/cm3]: 222.1 vs. 317.4, p = 0.000；RTA患者的中位小梁vBMD [mg HA/cm3]: 69.0 vs. 160.9, p = 0.000)。两组间皮质vBMD具有可比性。显微结构分析显示RTA患者桡骨和胫骨小梁数量减少，小梁分离增加，小梁骨不均匀性增加，皮质厚度减少。结论成人RTA患者表现为高骨转换，小梁vBMD降低，骨微结构受损，尤其是小梁骨。
期刊介绍：
Archives of Osteoporosis is an international multidisciplinary journal which is a joint initiative of the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA. The journal will highlight the specificities of different regions around the world concerning epidemiology, reference values for bone density and bone metabolism, as well as clinical aspects of osteoporosis and other bone diseases.
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