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Decrease in thoracic vertebral bone attenuation with calcium-based phosphate binders in hemodialysis.
J Bone Miner Res. 2005 May; 20(5):764-72.JB

Abstract

We performed a post hoc analysis of a 52-week randomized trial conducted in adult hemodialysis patients that compared the effects of calcium-based phosphate binders and sevelamer, a nonabsorbable polymer, on parameters of mineral metabolism and vascular calcification by electron beam tomography. In this analysis, we evaluated the relative effects of calcium and sevelamer on thoracic vertebral attenuation by CT and markers of bone turnover. Subjects randomized to calcium salts experienced a significant reduction in trabecular bone attenuation and a trend toward reduction in cortical bone attenuation, in association with higher concentrations of serum calcium, lower concentrations of PTH, and reduced total and bone-specific alkaline phosphatase.

INTRODUCTION

In patients with chronic kidney disease, hyperphosphatemia is associated with osteodystrophy, vascular and soft tissue calcification, and mortality. Calcium-based phosphate binders are commonly prescribed to reduce intestinal phosphate absorption and to attenuate secondary hyperparathyroidism. Clinicians and investigators have presumed that, in hemodialysis patients, calcium exerts beneficial effects on bone.

MATERIALS AND METHODS

We performed a post hoc analysis of a 52-week randomized trial conducted in adult hemodialysis patients that compared the effects of calcium-based phosphate binders and sevelamer, a nonabsorbable polymer, on parameters of mineral metabolism and vascular calcification by electron beam tomography. In this analysis, we evaluated the relative effects of calcium and sevelamer on thoracic vertebral attenuation by CT and markers of bone turnover.

RESULTS AND CONCLUSIONS

The average serum phosphorus and calcium x phosphorus products were similar for both groups, although the average serum calcium concentration was significantly higher in the calcium-treated group. Compared with sevelamer-treated subjects, calcium-treated subjects showed a decrease in thoracic vertebral trabecular bone attenuation (p = 0.01) and a trend toward decreased cortical bone attenuation. More than 30% of calcium-treated subjects experienced a 10% or more decrease in trabecular and cortical bone attenuation. On study, sevelamer-treated subjects had higher concentrations of total and bone-specific alkaline phosphatase, osteocalcin, and PTH (p < 0.001). When used to correct hyperphosphatemia, calcium salts lead to a reduction in thoracic trabecular and cortical bone attenuation. Calcium salts may paradoxically decrease BMD in hemodialysis patients.

Authors+Show Affiliations

Tulane University School of Medicine, New Orleans, Louisiana, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15824849

Citation

Raggi, Paolo, et al. "Decrease in Thoracic Vertebral Bone Attenuation With Calcium-based Phosphate Binders in Hemodialysis." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 20, no. 5, 2005, pp. 764-72.
Raggi P, James G, Burke SK, et al. Decrease in thoracic vertebral bone attenuation with calcium-based phosphate binders in hemodialysis. J Bone Miner Res. 2005;20(5):764-72.
Raggi, P., James, G., Burke, S. K., Bommer, J., Chasan-Taber, S., Holzer, H., Braun, J., & Chertow, G. M. (2005). Decrease in thoracic vertebral bone attenuation with calcium-based phosphate binders in hemodialysis. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 20(5), 764-72.
Raggi P, et al. Decrease in Thoracic Vertebral Bone Attenuation With Calcium-based Phosphate Binders in Hemodialysis. J Bone Miner Res. 2005;20(5):764-72. PubMed PMID: 15824849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decrease in thoracic vertebral bone attenuation with calcium-based phosphate binders in hemodialysis. AU - Raggi,Paolo, AU - James,George, AU - Burke,Steven K, AU - Bommer,Jürgen, AU - Chasan-Taber,Scott, AU - Holzer,Herwig, AU - Braun,Johan, AU - Chertow,Glenn M, Y1 - 2004/12/20/ PY - 2004/06/22/received PY - 2004/09/28/revised PY - 2004/12/14/accepted PY - 2005/4/13/pubmed PY - 2005/8/20/medline PY - 2005/4/13/entrez SP - 764 EP - 72 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J Bone Miner Res VL - 20 IS - 5 N2 - UNLABELLED: We performed a post hoc analysis of a 52-week randomized trial conducted in adult hemodialysis patients that compared the effects of calcium-based phosphate binders and sevelamer, a nonabsorbable polymer, on parameters of mineral metabolism and vascular calcification by electron beam tomography. In this analysis, we evaluated the relative effects of calcium and sevelamer on thoracic vertebral attenuation by CT and markers of bone turnover. Subjects randomized to calcium salts experienced a significant reduction in trabecular bone attenuation and a trend toward reduction in cortical bone attenuation, in association with higher concentrations of serum calcium, lower concentrations of PTH, and reduced total and bone-specific alkaline phosphatase. INTRODUCTION: In patients with chronic kidney disease, hyperphosphatemia is associated with osteodystrophy, vascular and soft tissue calcification, and mortality. Calcium-based phosphate binders are commonly prescribed to reduce intestinal phosphate absorption and to attenuate secondary hyperparathyroidism. Clinicians and investigators have presumed that, in hemodialysis patients, calcium exerts beneficial effects on bone. MATERIALS AND METHODS: We performed a post hoc analysis of a 52-week randomized trial conducted in adult hemodialysis patients that compared the effects of calcium-based phosphate binders and sevelamer, a nonabsorbable polymer, on parameters of mineral metabolism and vascular calcification by electron beam tomography. In this analysis, we evaluated the relative effects of calcium and sevelamer on thoracic vertebral attenuation by CT and markers of bone turnover. RESULTS AND CONCLUSIONS: The average serum phosphorus and calcium x phosphorus products were similar for both groups, although the average serum calcium concentration was significantly higher in the calcium-treated group. Compared with sevelamer-treated subjects, calcium-treated subjects showed a decrease in thoracic vertebral trabecular bone attenuation (p = 0.01) and a trend toward decreased cortical bone attenuation. More than 30% of calcium-treated subjects experienced a 10% or more decrease in trabecular and cortical bone attenuation. On study, sevelamer-treated subjects had higher concentrations of total and bone-specific alkaline phosphatase, osteocalcin, and PTH (p < 0.001). When used to correct hyperphosphatemia, calcium salts lead to a reduction in thoracic trabecular and cortical bone attenuation. Calcium salts may paradoxically decrease BMD in hemodialysis patients. SN - 0884-0431 UR - https://www.unboundmedicine.com/medline/citation/15824849/Decrease_in_thoracic_vertebral_bone_attenuation_with_calcium_based_phosphate_binders_in_hemodialysis_ L2 - https://doi.org/10.1359/JBMR.041221 DB - PRIME DP - Unbound Medicine ER -