Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan.
Clin J Am Soc Nephrol. 2010 Feb;5(2):292-8. doi: 10.2215/CJN.04150609. Epub 2010 Jan 21.
A new assessment system for bone histology, termed the turnover-mineralization-volume system, is advocated for patients with chronic kidney disease-related mineral and bone disorder. The system measures cancellous bone volume (BV/TV) as a third major evaluation axis; however, the physiologic significance of BV/TV remains unclear.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Conventional bone histomorphometry was performed in 75 iliac bone samples obtained from dialysis patients. In 47 of the 75 samples, the remaining samples were subjected to direct microfocus x-ray computed tomographic observation. Quantitative morphologic examinations, including micro-bone mineral densitometry, and marrow space star volume, Euler number, and node-strut analyses, were performed in the virtual three-dimensional space reconstructed from the microfocus x-ray computed tomographic images.
The levels of BV/TV were comparable in each of the conventional bone histomorphometric criteria. No significant correlations were found between BV/TV and other parameters. Two- and three-dimensional BV/TVs were significantly correlated with cancellous bone mass but not with cortical bone thickness or cortical bone mass. Two- and three-dimensional BV/TVs were significantly correlated with trabecular bone connectivity as determined by marrow space star volume, Euler number, and node-strut analyses.
In dialysis patients, BV/TV is not dependent on bone turnover or bone mineralization. BV/TV is unlikely to indicate the balance between bone formation and bone resorption. Instead, it reflects trabecular bone connectivity, and improved trabecular bone connectivity is physiologically beneficial in terms of bone quality. The turnover-mineralization-volume system offers an advantage over the conventional system for the assessment of bone quality.
一种新的骨组织学评估系统，即转换-矿化-容积系统，被提倡用于慢性肾脏病相关矿物质和骨代谢紊乱患者。该系统将松质骨体积 (BV/TV) 作为第三个主要评估轴；然而，BV/TV 的生理意义尚不清楚。
设计、地点、参与者和测量：对 75 例透析患者的髂骨样本进行了常规骨组织形态计量学检查。在 75 个样本中的 47 个样本中，其余样本进行了直接微焦点 X 射线计算机断层扫描观察。在从微焦点 X 射线计算机断层扫描图像重建的虚拟三维空间中进行了定量形态学检查，包括微骨矿物质密度、骨髓空间星体积、欧拉数和节点-支柱分析。
在每个常规骨组织形态计量学标准中，BV/TV 的水平相当。BV/TV 与其他参数之间没有发现显著相关性。二维和三维 BV/TV 与松质骨量显著相关，但与皮质骨厚度或皮质骨量无关。二维和三维 BV/TV 与骨髓空间星体积、欧拉数和节点-支柱分析确定的小梁骨连通性显著相关。
在透析患者中，BV/TV 不受骨转换或骨矿化的影响。BV/TV 不太可能表示成骨和破骨之间的平衡。相反，它反映了小梁骨的连通性，改善的小梁骨连通性在骨质量方面具有生理益处。转换-矿化-容积系统在评估骨质量方面优于传统系统。
