Case report

Electron microscopic evaluation of bone from a patient treated with cinacalcet hydrochloride, maxacalcitol, and alfacalcidol for hyperparathyroid bone disease with secondary hyperparathyroidism

A. Yajima, K. Tsuchiya, Lynda Bonewald, M. Inaba, Y. Tominaga, T. Tanizawa, A. Ito, K. Nitta

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalOsteoporosis International
DOIs
StateAccepted/In press - Feb 28 2018

Fingerprint

Secondary Hyperparathyroidism
Bone Diseases
Electrons
Bone and Bones
Osteocytes
Porosity
Chronic Renal Insufficiency
Calcitriol Receptors
Therapeutics
Osteoblasts
Renal Dialysis
Electron Microscopy
maxacalcitol
alfacalcidol
Cinacalcet Hydrochloride

Keywords

  • Alfacalcidol
  • Cinacalcet hydrochloride
  • Electron microscope
  • Hyperparathyroid bone disease
  • Hypomineralized matrix
  • Maxacalcitol

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

@article{0216ef6156fb4197aa85d6e39a757244,
title = "Case report: Electron microscopic evaluation of bone from a patient treated with cinacalcet hydrochloride, maxacalcitol, and alfacalcidol for hyperparathyroid bone disease with secondary hyperparathyroidism",
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.",
keywords = "Alfacalcidol, Cinacalcet hydrochloride, Electron microscope, Hyperparathyroid bone disease, Hypomineralized matrix, Maxacalcitol",
author = "A. Yajima and K. Tsuchiya and Lynda Bonewald and M. Inaba and Y. Tominaga and T. Tanizawa and A. Ito and K. Nitta",
year = "2018",
month = "2",
day = "28",
doi = "10.1007/s00198-018-4402-3",
language = "English (US)",
pages = "1--7",
journal = "Osteoporosis International",
issn = "0937-941X",
publisher = "Springer London",

}

TY - JOUR

T1 - Case report

T2 - Electron microscopic evaluation of bone from a patient treated with cinacalcet hydrochloride, maxacalcitol, and alfacalcidol for hyperparathyroid bone disease with secondary hyperparathyroidism

AU - Yajima, A.

AU - Tsuchiya, K.

AU - Bonewald, Lynda

AU - Inaba, M.

AU - Tominaga, Y.

AU - Tanizawa, T.

AU - Ito, A.

AU - Nitta, K.

PY - 2018/2/28

Y1 - 2018/2/28

N2 - 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.

AB - 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.

KW - Alfacalcidol

KW - Cinacalcet hydrochloride

KW - Electron microscope

KW - Hyperparathyroid bone disease

KW - Hypomineralized matrix

KW - Maxacalcitol

UR - http://www.scopus.com/inward/record.url?scp=85042606335&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042606335&partnerID=8YFLogxK

U2 - 10.1007/s00198-018-4402-3

DO - 10.1007/s00198-018-4402-3

M3 - Article

SP - 1

EP - 7

JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

ER -