Bone alkaline phosphatase isoenzyme in renal osteodystrophy

Nephrology Service, Hospital Universitario Virgen Macarena, Seville, Spain.
Nephrology Dialysis Transplantation (Impact Factor: 3.58). 01/1996; 11 Suppl 3(supp3):43-6. DOI: 10.1093/ndt/11.supp3.43
Source: PubMed


Serum total alkaline phosphatase is the most commonly used biochemical marker of bone disease in renal patients, but alkaline
phosphatase originates from. different organs and sometimes lacks specificity. Bone isoenzyme measurement is considered superior
to total alkaline phosphatase for the assessment of bone metabolism. We have studied the value of bone isoenzyme, determined
by a new IRMA (Tandem-R Ostase), in haemodialysis patients with secondary hyperparathyroidism and renal osteodystrophy. Fiftysix
haemodialysis patients were studied. Intact parathyroid hormone (PTH), osteocalcin, total alkaline phosphatase and bone alkaline
phosphatase were determined. A transiliac bone biopsy was performed in 20 of the 56 patients after double tetracycline labelling.
There was a significant correlation between bone alkaline phosphatase and PTH (r=0.79, P<0.0O1) and between bone and total alkaline phosphatase (r = 0.84, P<0.001) in all patients. The patients who underwent a bone biopsy showed osteitis fibrosa in 17, mixed lesion in one, adynamic
bone disease in one and normal bone in one. Bone alkaline phosphatase showed significant correlation with static and dynamic
histomorphometric indices similar to that obtained with PTH and better than those of total alkaline phosphatase and osteocalcin.
It is concluded that bone alkaline phosphatase (ostase) seems to be a useful non-invasive marker of bone metabolism in patients
on haemodialysis with high turnover bone disease. More studies are necessary to know its value in low turnover bone disease.

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