Evolución de los marcadores óseos durante el tratamiento con cinacalcet en pacientes con hiperparatiroidismo secundario en hemodiálisis

Zusammenfassung

Background and aims: Cinacalcet belongs to a new class of drugs that improves the sensitivity of parathyroid cells to calcium. Although this drug reduces parathyroid hormone (PTH) levels in secondary hyperparathyroidism (SHPT) unresponsive to standard therapy, its effect on bone remodeling is unknown. The aim of the present study was to describe the effect of cinacalcet on two markers of bone remodeling, beta-crosslap (a marker of bone resorption) and N-MID osteocalcin (a marker of bone formation) in patients with chronic kidney disease stage 5-D with SHPT. Material and method: We performed a non-randomized observational study in 10 hemodialysis patients with SHPT treated with cinacalcet over a 21 week-period. Calcium-phosphorus metabolism, including beta-crosslap and N-MID osteocalcin, was sequentially analyzed. Results: The mean PTH level decreased from the third week (from 726 ± 396 pg/ml to 427.8 ± 208.10 pg/ml; p < 0.01), and this decrease was more marked in the 21st week (181.2 ± 74.10 pg/ml; p < 0.01). No changes were observed in calcemia or phosphoremia. Beta-crosslap and osteocalcin levels showed a non-significant decrease (baseline beta-crosslap 3,052.8 ± 1,417.40 pg/ml vs. 1,001.2 ± 389.43 pg/ml in week 19; baseline osteocalcin 549.4 ± 572.96 vs. 216.4 ± 88.7 ng/mL in week 19). Levels of both markers increased from week 21 on. Conclusions: Our data suggest that, in addition to reducing PTH levels in uremic patients with SHPT, cinacalcet modifies bone remodeling with a tendency to reduce levels of beta-crosslap and osteocalcin.