Sclerostin serum levels correlate positively with bone mineral density and microarchitecture in haemodialysis patients

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2012, Vol.27 (1), p.226-230
• Main Authors: CEJKA, Daniel, JÄGER-LANSK, Agnes, HAAS, Martin, KIEWEG, Heidi, WEBER, Michael, BIEGLMAYER, Christian, HAIDER, Dominik G, DIARRA, Danielle, PATSCH, Janina M, KAINBERGER, Franz, BOHLE, Barbara
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Bone and Bones - anatomy & histology; Bone Density; Bone mineral density; Bone Morphogenetic Proteins - blood; Bone turnover; Calcium; Case-Control Studies; Computed tomography; Cross-Sectional Studies; Dkk1 protein; Dual energy X-ray absorptiometry; Emergency and intensive care: renal failure. Dialysis management; Female; Femur; Genetic Markers; Hemodialysis; Humans; Intensive care medicine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Miscellaneous. Technology; Multivariate analysis; Osteoblasts; Osteogenesis; Parathyroid hormone; Parathyroid Hormone - blood; Prognosis; Radius; Renal Dialysis; Serum levels; SOST protein; Spine (lumbar); Tibia; Ultrasonic investigative techniques; Vitamin D
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr270

Sclerostin is a soluble inhibitor of osteoblast function. Sclerostin is downregulated by the parathyroid hormone (PTH). Here, it was investigated whether sclerostin levels are influenced by intact (i) PTH and whether sclerostin is associated with bone turnover, microarchitecture and mass in dialysis patients. Seventy-six haemodialysis patients and 45 healthy controls were included in this cross-sectional study. Sclerostin, Dickkopf-1 (DKK-1), intact parathyroid hormone (iPTH), vitamin D and markers of bone turnover were analysed. A subset of 37 dialysis patients had measurements of bone mineral density (BMD) using dual-energy X-ray absorptiometry and bone microarchitecture using high-resolution peripheral quantitative computed tomography. Dialysis patients had significantly higher sclerostin levels than controls (1257 pg/mL versus 415 pg/mL, P < 0.001). Significant correlations were found between sclerostin and gender (R = 0.41), iPTH (R = -0.28), 25-hydroxy-cholecalciferol (R = 0.27) and calcium (R = 0.25). Gender and iPTH remained significantly associated with sclerostin in a multivariate analysis. Sclerostin serum levels were positively associated with BMD at the lumbar spine (R = 0.46), femoral neck (R = 0.36) and distal radius (R = 0.42) and correlated positively mainly with trabecular structures such as trabecular density and number at the radius and tibia in dialysis patients. DKK-1 was related neither to bone measures nor to serologic parameters. Considering that sclerostin is an inhibitor of bone formation, the observed positive correlations of serum sclerostin with BMD and bone volume were unexpected. Whether its increase in dialysis patients has direct pathogenetic relevance or is only a secondary phenomenon remains to be seen.