Abstract
In order to evaluate a prospective bone metabolism value, several acknowledged parameters, including pyridinoline (PYR) and deoxypyridinoline (DPYR), were compared with resorptive changes seen on X-ray film over a 2 year follow-up period in 48 hemodialyzed patients who did not have elevations in serum total alkaline phosphatase (ALP) activity and no radiological resorptive signs more severe than grade 1 of Jensen's criteria. Twelve patients (25%) showed progression of resorptive change on X-ray film at the 2 year examination. Data were analyzed for two patient groups, i.e. one with progression of resorptive signs and another 36 patients (75%) without such radiographic signs. All parameters other than tartrate resistant acid phosphatase (TRACP) were significantly higher in the former patient group than in the latter, but considerable overlap was recognized between the two patient groups in total ALP, bone ALP and bone Gla-protein. In contrast, very few of such overlapping cases were seen for PYR and DPYR. Based on these results, we assume that all chemical bone markers other than TRACP are useful to some extent, but are not satisfactory as predictive indicators for resorptive bone damage. However, PYR and DPYR may prove to be reliable indicators of the potential progression of resorptive bone change in subclinical renal osteodystrophy patients.
