This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lafage-Proust, M.-H. Articles by Aparicio, M. Search for Related Content PubMed PubMed Citation Articles by Lafage-Proust, M.-H. Articles by Aparicio, M.

Bone Mass and Dynamic Parathyroid Function According to Bone Histology in Nondialyzed Uremic Patients after Long-Term Protein and Phosphorus Restriction

Faculté de Médecine, Laboratoire de Biologie du Tissu Osseux (M.-H.L.-P.), Saint-Etienne; and Maladies Médicales des Reins (C.C., M.A.) and Service de Médecine Nucléaire (N.B.), Hôpital Pellegrin-Tripode, Bordeaux, France

Address all correspondence and requests for reprints to: Dr. Marie-Helene Lafage-Proust, Faculté de Médecine, Laboratoire de Biologie du Tissu Osseux, 15 rue A Paré, 42023 Saint Etienne Cedex 2, France. E-mail: lbto{at}univ-st-etienne.fr

One year of a very low protein diet (VLPD) can reverse secondary hyperparathyroidism in uremic patients. We studied bone histology, bone mineral density (BMD), and dynamic parathyroid function (calcium/PTH curves) in 16 nondialyzed patients with advanced renal failure who had been receiving a VLPD for a mean of 5 yr (mean protein intake, 0.34 ± 0.12 mg/kg·day; mean phosphorus intake, 8.2 ± 2.1 mg/kg·day) and daily supplementation with essential amino acids and their ketoanalogs (1000 IU vitamin D₂ and 1–2 g calcium carbonate). Three patients exhibited a high bone formation rate (BFR), 7 patients had normal bone remodeling, and 6 patients had a low BFR, including 2 with osteomalacia and 4 with adynamic bone disease without aluminum overload. A longer diet duration and lower caloric intake were associated with low BFR. More than half of the patients exhibited moderate or severe osteoporosis at the appendicular skeleton. The t score of femur BMD explained 65% of the BFR variance. Patients with a low BFR had a dynamic parathyroid function similar to that of patients with a normal BFR, except they had a lower capacity to buffer a calcium load, whereas patients with a high BFR had a higher basal PTH/maximum PTH and a steeper calcium/PTH curve slope; the calcium set-point was identical in the three groups.

This article has been cited by other articles:

				G. Saab, A. T. Whaley-Connell, R. Khanna, and J. R. Sowers Review: Therapy for the altered mineral metabolism of chronic kidney disease: implications for vascular calcification Therapeutic Advances in Cardiovascular Disease, December 1, 2007; 1(2): 107 - 112. [Abstract] [PDF]

				F. Locatelli, D. Fouque, O. Heimburger, T. B. Drueke, J. B. Cannata-Andia, W. H. Horl, and E. Ritz Nutritional status in dialysis patients: a European consensus Nephrol. Dial. Transplant., April 1, 2002; 17(4): 563 - 572. [Abstract] [Full Text] [PDF]