Bone histomorphometry of renal osteodystrophy in diabetic patients

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Abstract
Bone biopsies and plasma parathyroid hormone (PTH) from 27 diabetic dialysis patients were compared to biopsies and PTH levels from matched patients without diabetes to determine if PTH has a role in preserving bone mass in diabetic renal osteodystrophy. Significantly lower values were present in the diabetic group for mineralized bone area (p < 0.003), osteoblastic osteoid (p < 0.01), resorptive surface (p < 0.001), fibrosis (p < 0.005), bone apposition rate (p < 0.01), bone formation rate (BMU level) (p < 0.04), and plasma PTH (p < 0.05). Bone-surface aluminum was higher in the diabetic group (44 ± 5% vs. 20 ± 5%, p < 0.005). Linear regression analysis revealed significant positive correlations of mineralized bone area with time on dialysis, bone formation rate, bone resorption, and PTH only in the group without diabetes. While both groups had significant positive correlations of PTH with osteoblastic osteoid and bone resorption, only in the nondiabetic group was there a positive correlation of PTH with bone apposition and bone formation rate (BMU level), observations suggesting that the lower bone formation in the diabetic patients may have arisen in part from a failure of PTH to promote bone mineralization. We conclude that relatively low PTH levels and high bone aluminum in diabetic patients with chronic renal failure may be responsible in part for low bone mass when compared to uremic patients without diabetes.
Funding Information
  • VA Medical Research Funds