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Yajima A, Tsuchiya K, Bonewald LF, Inaba M, Tominaga Y, Tanizawa T, Ito A, Nitta K. Case report: Electron microscopic evaluation of bone from a patient treated with cinacalcet hydrochloride, maxacalcitol, and alfacalcidol for hyperparathyroid bone disease with secondary hyperparathyroidism. Osteoporos Int 2018; 29:1203-1209. [PMID: 29492624 DOI: 10.1007/s00198-018-4402-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 01/18/2018] [Indexed: 11/27/2022]
Abstract
Evaluation of bone is of great importance in chronic kidney disease patients, as these patients are at an increased risk for fractures. We treated a hemodialysis patient suffering from hyperparathyroid bone disease with cinacalcet hydrochloride and concurrent administration of maxacalcitol and alfacalcidol for a year. Hyperparathyroid bone disease is characterized by cortical thinning, increased cortical porosity, reduced trabecular bone volume, and increased hypomineralized matrix volume, and there is little information to date about the effects of treatment with cinacalcet hydrochloride on the bone fragility in patients with hyperparathyroid bone disease. In the present study, histological and backscattered electron microscopic evaluation of this combination treatment revealed an excellent improvement of both bone volume and bone morphology. This treatment improved cortical thinning, cortical porosity, and trabecular thinning. Furthermore, the treatment also reduced hypomineralized matrix volume, indicative of improved mineralization by osteocytes. We speculate that the intermittent maxacalcitol administration may have effectively stimulated the vitamin D receptors expressed on osteocytes and osteoblasts, resulting in increased mineralization. Our approach for evaluating the bone in patients with chronic kidney disease by backscattered electron microscopy is novel.
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Affiliation(s)
- A Yajima
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - K Tsuchiya
- Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - L F Bonewald
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Oral and Craniofacial Sciences, University of Missouri, School of Dentistry, Kansas City, MI, USA
| | - M Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University, Abeno-ku, Osaka, Japan
| | - Y Tominaga
- Department of Endocrine Surgery, Nagoya Second Red Cross Hospital, Nagoya, Aichi, Japan
| | - T Tanizawa
- Department of Orthopedic Surgery, Tanizawa Clinic, Niigata, Niigata, Japan
| | - A Ito
- Ito Bone Histomorphometry Institute, Niigata, Niigata, Japan
| | - K Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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