Bone Abstracts

Osteoarthritis and osteoporosis are two elderly conditions characterized by two different pathophysiological mechanisms. In patients with chronic kidney disease (CKD), there is a metabolic impairment of the muscular-skeletal tissue. The aim of our study is to evaluate the biochemical and morphostructural alterations in different states of CKD in patients with osteoarthritis or hip fracture.

We evaluated all patients undergoing hip replacement surgery from January 2012 to April 2015 for femoral neck fracture or hip osteoarthritis. For each patient, we evaluated bone metabolism and the kidney function by blood chemistry; glomerular filtration was calculated by CKD-EPI method and the patients were divided, according to the degree of CKD, in five groups. For each patient were performed bone mineral density (BMD) evaluation and histomorphometric analysis of the bone sample taken from the femoral head during surgery.

The total of 272 patients (92 men and 180 women, average age 76.1) were included in the study. They underwent surgery for fracture (n=144) or osteoarthritis (n=128). The patients with grade I (n=43) and II (n=112) were arthritic respectively in 65 and 60%, while patients with grade III (n=99), IV (n=14) and V (n=4) were fractured respectively 69, 92 and 75%. PTH was lower in patients with grade I and II (P<0.01), vitamin D in patients grade III and IV (P<0.01). The BMD values were lower with the decrease in renal function both in osteoarthritic patients than in the fractured ones. Histomorphometric analysis showed a progressive decrease of the structural parameters of the bone with a bone volume significantly lower in patients with stage III–IV (0.525 mm²) compared with grades I–II (0.63 mm², P<0.01) as well as even a reduced trabecular thickness (13.88 vs 16:54, P<0.01).

Biochemical markers could be predictors of bone histomorphometric alterations in patients with CKD in patients with osteoarthritis and osteoporosis.