Osteodystrophy of diabetics in chronic dialysis: A histomorphometric study

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Abstract
A decreased incidence of hyperparathyroidism in diabetic uremic patients has been reported, but comprehensive bone histomorphometric studies on uremic diabetic osteodistrophy are scarce. We present here the results of static and dynamic bone morphometry in 13 diabetic patients on dialysis (DCD) and their comparison with a pairmatched group of nondiabetic uremics with similar age, sex, and time on dialysis (NCDC), and with a group of 17 normals (N). Diabetic bone showed: (1) Low trabecular volume (Vt 9.9% in DCD and 22.8% in N), (2) Moderately increased remodeling values of intermediate intensity between N and NDCD values (Sf=19.3% in DCD, 37.4% in NDCD, and 8.8±6% in N, Sr=4.3% in DCD, 7.3% in NDCD and 2.04±0.9% in N), and (3) Moderate fibrosis (Sfib 1.2% in DCD, 12.9% in NDCD). Besides these confirmatory results, two suggestions emerged from the study: (1) The relative number of cells: osteoclast density (OI) and osteoblasts (Ob/OID) appears to be lower not only than NDCD values but also lower than N values (OI=0.04 c/mm. in DCD, 0.31 in NDCD, and 0.14 in N; Ob/OID=5.58% in DCD, 14.6 in NDCD and 22.12±9% m N). (2) Dynamic behavior in tetracycline based studies disclosed the appearance of two populations of DCD: a subgroup of preserved calcification dynamics with values not quite different than the NDCD group and a subgroup with a significant derangement of mineralization with no measurable bone trabecular dynamics. This late subgroup also showed significantly lower number of Ob/OID values compared with the former with preserved calcification. Both findings may agree with other reported experimental evidences on diabetes.