Arjunan Durairaj, Mukherjee Soham, Bhadada Sanjay K, Ghosh Jayaditya, Shah Ravi, S Subin, Hussain Sadam, Pal Rimesh, Naidu Gsrsnk, Dutta Pinaki
Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
Department of Internal Medicine, PGIMER, Chandigarh, 160012, India.
Arch Osteoporos. 2025 May 13;20(1):63. doi: 10.1007/s11657-025-01545-0.
Adults with renal tubular acidosis (RTA) show high bone turnover, reduced trabecular volumetric bone mineral density (vBMD), and compromised bone microarchitecture, especially in trabecular bone. HR-pQCT analysis reveals lower total vBMD, reduced trabecular number, increased separation, and cortical thinning, highlighting bone deterioration in RTA patients compared to controls.
Renal tubular acidosis (RTA) impairs urinary acidification, leading to a normal anion gap metabolic acidosis and often hypokalemia. RTA can result in poor bone mineralization and reduced bone density in adults. This study aims to evaluate bone microarchitecture in adults with RTA using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT).
In this cross-sectional case-control study, 12 adult RTA patients with rickets/osteomalacia and 12 age, sex, and BMI-matched controls were enrolled. Clinical assessments, biochemical tests with calcium, phosphate, alkaline phosphatase, 25(OH)D, intact PTH, bone turnover markers, dual-energy X-ray absorptiometry (DXA), and HR-pQCT scans were conducted.
Patients with RTA had increased bone turnover compared to the controls. RTA patients had significantly lower total hip areal bone mineral density (aBMD) [g/cm] (median, 0.792 vs. 0.943; p = 0.014) and lower distal radius aBMD [g/cm] (median, 0.469 vs. 0.694, p 0.000), compared to controls. HR-pQCT findings suggest lower total and trabecular volumetric BMD (v.BMD), at both the radius (median total vBMD [mg HA/cm]: 236 vs. 380.1, p = 0.001; median trabecular vBMD [mg HA/cm]; 83.4 vs. 170.1, p = 0.000) and tibia (median total vBMD [mg HA/cm]: 222.1 vs. 317.4, p = 0.000; median trabecular vBMD [mg HA/cm]: 69.0 vs. 160.9, p = 0.000) in RTA patients compared to controls. Cortical vBMD was comparable between groups. Microarchitecture analysis revealed reduced trabecular number, increased trabecular separation, increased trabecular bone inhomogeneity, and reduced cortical thickness in RTA patients, both at radius and tibia.
Adults with RTA exhibit high bone turnover, reduced trabecular vBMD, and compromised bone microarchitecture, particularly in trabecular bone.
患有肾小管性酸中毒（RTA）的成年人表现出高骨转换、小梁骨体积骨密度（vBMD）降低以及骨微结构受损，尤其是在小梁骨中。高分辨率外周定量计算机断层扫描（HR-pQCT）分析显示，与对照组相比，RTA患者的总vBMD较低、小梁数量减少、间距增加以及皮质变薄，突出了RTA患者的骨质恶化情况。
肾小管性酸中毒（RTA）会损害尿液酸化，导致正常阴离子间隙代谢性酸中毒，且常伴有低钾血症。RTA可导致成年人骨矿化不良和骨密度降低。本研究旨在使用第二代高分辨率外周定量计算机断层扫描（HR-pQCT）评估患有RTA的成年人的骨微结构。
在这项横断面病例对照研究中，纳入了12名患有佝偻病/骨软化症的成年RTA患者以及12名年龄、性别和体重指数（BMI）相匹配的对照者。进行了临床评估、钙、磷、碱性磷酸酶、25（OH）D、完整甲状旁腺激素、骨转换标志物的生化检测、双能X线吸收法（DXA）以及HR-pQCT扫描。
与对照组相比，RTA患者的骨转换增加。与对照组相比，RTA患者的全髋部面积骨密度（aBMD）[g/cm]显著更低（中位数，0.792对0.943；p = 0.014），桡骨远端aBMD[g/cm]也更低（中位数，0.469对0.694，p < 0.000）。HR-pQCT结果表明，RTA患者在桡骨（中位数总vBMD[mg HA/cm]：236对380.1，p = 0.001；中位数小梁vBMD[mg HA/cm]：83.4对170.1，p = 0.000）和胫骨（中位数总vBMD[mg HA/cm]：222.1对317.4，p = 0.000；中位数小梁vBMD[mg HA/cm]：69.0对160.9，p = 0.000）处的总vBMD和小梁vBMD均低于对照组。两组间皮质vBMD相当。微结构分析显示，RTA患者在桡骨和胫骨处的小梁数量减少、小梁间距增加、小梁骨不均匀性增加以及皮质厚度减小。
患有RTA的成年人表现出高骨转换、小梁vBMD降低以及骨微结构受损，尤其是在小梁骨中。
