Serum Bone Gla-Protein in Renal Osteodystrophy:Comparison with Bone Histomorphometry*

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Abstract
Serum bone Gla-protein (S-BGP) and other serum biochemical parameters, including alkaline phosphatase (SAP) and immunoreactive PTH(S-iPTH), were measured in 42 patients undergoing chronic hemodialysis. Each patient alsohad a tetracycline-labeled transiliac bone biopsy, allowingcorrelations between the biochemical and trabecular bone histomorphometric parameters. S-BGP was markedly increased [64.0 ± 74.8 (±SD) VS. 6.2 ± 2.2 ng/ml in normal subjects] and significantly correlated with S-AP (r = 0.53) and S-iPTH (r = 0.55) levels. S-BGP was significantly higher in the 14 patients with high turnover renal osteodystrophy (HT-ROD; S-BGP, 138.5 ± 90.8 ng/ml) than in the 28 patients with low turnover (LT-ROD; S-BGP, 26.8 ± 14.8 ng/ml).S-BGP was significantly correlated with the cellular parameters of bone resorption and formation (r = 0.57–0.69) and with the dynamic parameters of bone formation (r = 0.62–0.82). The extent of stainable bone aluminum was significantly negatively correlated with S-BGP (r = −0.51) and serum iPTH (r = −0.33), but not with S-AP.S-BGP measurement allowed better discrimination between LT-ROD and HT-ROD groups than did S-AP measurement. However, in the patients with LT-ROD, S-BGP did not discriminate between patients with or without osteomalacia. We conclude that S-BGP is a valuable marker for evaluating bone remodeling and, more specifically, the bone formation rate at the tissue level in hemodialyzed patients.