RESUMO
The objective of this study was to assess the relationship between the bone strontium content and bone histomorphometric parameters in bone biopsies from patients with chronic renal failure undergoing hemodialysis. The study was carried out in 74 illiac crest bone biopsies from patients with renal osteodystrophy from different worldwide regions (Argentina, Portugal and Spain). They were underwent to histological and histomorphometric evaluation. The bone strontium/calcium ratio was measured by quadrupole inductively coupled plasma-mass spectrometry. The samples were classified into groups according to histological criteria: hyperparathyroidism (HP), mixed (MX), osteomalacia (OM) and adynamic bone disease (ABD). Serum PTH and alkaline phosphatase before biopsy were available in most of the patients. No correlation was found between the different histomorphometric parameters and the Sr/Ca ratio. The one way ANOVA test showed statistical differences in the Sr/Ca ratio of the different histological forms (HP: 0.58 +/- 0.39; MX: 1.16 +/- 0.74; OM: 1.10 +/- 0.46; ABD: 0.91 +/- 0.40 microgram Sr/mg Ca; p < 0.003). The post-Hoc analysis showed differences between HP and MX. The biopsies having greater or equal values than 1.4 micrograms Sr/mg Ca showed higher levels of bone formation histomorphometric parameters and serum alkaline phosphatase (395 +/- 519 vs 1,022 +/- 989 UI/L, p < 0.05). Although it has been found that the biopsies with higher bone strontium had higher levels of osteoid tissue (characteristic of osteomalacia), the hypothesis of strontium-induced osteomalacia could not be demonstrated.
Assuntos
Osso e Ossos/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Soluções para Hemodiálise/efeitos adversos , Falência Renal Crônica/metabolismo , Osteomalacia/induzido quimicamente , Diálise Renal , Estrôncio/efeitos adversos , Fosfatase Alcalina/sangue , Argentina/epidemiologia , Biópsia , Osso e Ossos/química , Cálcio/análise , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Soluções para Hemodiálise/química , Humanos , Hiperparatireoidismo Secundário/etiologia , Ílio/química , Ílio/patologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Osteomalacia/epidemiologia , Osteomalacia/etiologia , Hormônio Paratireóideo/sangue , Portugal/epidemiologia , Diálise Renal/efeitos adversos , Espanha/epidemiologia , Estrôncio/análiseRESUMO
El objetivo de este estudio fue investigar la relación que existe entre el contenido de estroncio en el hueso y parámetros histomorfométricos óseos en biopsias de pacientes con insuficiencia renal crónica sometidos a hemodiálisis. El estudio se realizó sobre 74 biopsias óseas de cresta ilíaca de enfermos con osteodistrofia renal de distintas procedencias (Argentina, Portugal y España) que fueron sometidas a análisis histológico e histomorfométrico. Además se cuantificó estroncio y calcio en un fragmento de la biopsia mediante espectrometría de masas con fuente de plasma acoplado por inducción (ICP-MS). Las biopsias fueron clasificadas en cuatro grupos según criterios histológicos: hiperparatiroidismo (HP), enfermedad mixta (MX), osteomalacia (OM) y enfermedad ósea adinámica (EOA). También fueron medidos los niveles séricos de fosfatasa alcalina y de PTH intacta. No se encontró correlación entre los distintos parámetros histomorfométricos y la relación Sr/Ca. El análisis de varianza mostró diferencias significativas de Sr/Ca entre las distintas formas histológicas (HP: 0,58 ± 0,39; MX: 1,16 ± 0,74; OM: 1,10 ± 0,46; AD: 0,91 ± 0,40; p < 0,003), habiendo diferencias entre HP y MX (p < 0,005). Cuando se dividieron las biopsias en dos grupos de acuerdo al nivel de la relación Sr/Ca (estroncio bajo < 1,4 μg Sr/mg Ca, estroncio alto _ 1,4 μg Sr/mg Ca), se encontró que aquellas con estroncio elevado mostraron niveles más altos en parámetros de formación ósea. De los parámetros séricos analizados, solo la fosfatasa alcalina mostró valores incrementados en los pacientes con Sr elevado en el hueso (395 ± 519 vs 1.022 ± 989 UI/L). Si bien se ha encontrado que aquellas biopsias con estroncio elevado muestran niveles más altos de osteoide (compatible con osteomalacia), el grado de causalidad del mismo no ha quedado claramente establecido (AU)
The objective of this study was to assess the relationship between the bone strontium content and bone histomorphometric parameters in bone biopsies from patients with chronic renal failure undergoing hemodialysis. The study was carried out in 74 illiac crest bone biopsies from patients with renal osteodystrophy from different worldwide regions (Argentina, Portugal and Spain). They were underwent to histological and histomorphometric evaluation. The bone strontium/calcium ratio was measured by quadrupole inductively coupled plasma-mass spectrometry. The samples were classified into groups according to histological criteria: hyperparathyroidism (HP), mixed (MX), osteomalacia (OM) and adynamic bone disease (ABD). Serum PTH and alkaline phosphatase before biopsy were available in most of the patients. No correlation was found between the different histomorphometric parameters and the Sr/Ca ratio. The one way ANOVA test showed statistical differences in the Sr/Ca ratio of the different histological forms (HP: 0.58 ± 0.39; MX: 1.16 ± 0.74; OM: 1.10 ± 0.46; ABD: 0.91 ± 0.40 μg Sr/ mg Ca; p < 0.003). The post-Hoc analysis showed differences between HP and MX. The biopsies having greater or equal values than 1.4 μg Sr/mg Ca showed higher levels of bone formation histomorphometric parameters and serum alkaline phosphatase (395 ± 519 vs 1,022 ± 989 UI/L, p < 0.05) Although it has been found that the biopsies with higher bone strontium had higher levels of osteoid tissue (characteristic of osteomalacia), the hypothesis of strontium-induced osteomalacia could not be demonstrated (AU)