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, Paolo Raggi Tulane University School of Medicine, New Orleans, Louisiana, USA Search for other works by this author on: Oxford Academic George James Tulane University School of Medicine, New Orleans, Louisiana, USA Search for other works by this author on: Oxford Academic Steven K Burke Genzyme Drug Discovery and Development, Waltham, Massachusetts, USA Search for other works by this author on: Oxford Academic Jürgen Bommer Universitätsklinikum Heidelberg, Heidelberg, Germany Search for other works by this author on: Oxford Academic Scott Chasan‐Taber Pioneer BioDiligence, Amherst, Massachusetts, USA Search for other works by this author on: Oxford Academic Herwig Holzer Universitätsklinikum Graz, Graz, Austria Search for other works by this author on: Oxford Academic Johan Braun KfH Dialysezentrum Nürnberg, Nürnberg, Germany Search for other works by this author on: Oxford Academic Glenn M Chertow, MD, MPH University of California San Francisco, San Francisco, California, USA Search for other works by this author on: Oxford Academic
Journal of Bone and Mineral Research, Volume 20, Issue 5, 1 May 2005, Pages 764–772, https://doi.org/10.1359/JBMR.041221
Published:
04 December 2009
Article history
Received:
22 June 2004
Revision received:
28 September 2004
Accepted:
14 December 2004
Published:
04 December 2009
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Paolo Raggi, George James, Steven K Burke, Jürgen Bommer, Scott Chasan‐Taber, Herwig Holzer, Johan Braun, Glenn M Chertow, Decrease in Thoracic Vertebral Bone Attenuation With Calcium‐Based Phosphate Binders in Hemodialysis, Journal of Bone and Mineral Research, Volume 20, Issue 5, 1 May 2005, Pages 764–772, https://doi.org/10.1359/JBMR.041221
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Abstract
We performed a posthoc 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 posthoc 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 × 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.
calcium, sevelamer, hemodialysis, clinical trial, Hounsfield units, bone
Copyright © 2005 ASBMR
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
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