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Severe secondary hyperparathyroidism and panoramic radiography parameters

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Abstract

Objectives

Renal osteodystrophy (RO) are skeletal abnormalities seen in patients with secondary hyperparathyroidism (SHPT). This study aims to evaluate the effects of RO using panoramic radiography parameters. Furthermore, the correlation between these parameters and parathyroid hormone (PTH) levels was tested.

Materials and methods

Qualitative (mandibular cortical index/trabecular bone pattern) and quantitative parameters (mental index/calcification and resorption foci) were applied from panoramic radiographs of chronic kidney disease (CKD) patients and controls. Frequency distribution and descriptive analysis were used to compare the results of both groups. Spearman’s correlation coefficient evaluated the correlation between serum PTH levels of CKD patients and the radiographic parameters. Intra- and interobserver agreement was tested using the intraclass correlation coefficient and kappa index.

Results

Intra- and interobserver agreement was respectively excellent (0.81–1.00) and good (0.61–0.80). Qualitative parameters demonstrate significant difference compared with the control group. Mean mental index was lower in patients with CKD (3.17 ± 1.35 mm), but the difference was not significant. Calcification/resorption foci (3.63 ± 2.07) of CKD patients were significantly more present than in the control group (p = 0.0001). PTH levels were correlated with mental index, mandibular cortical index and trabecular bone pattern (respectively, 0.0034, 0.0315, and 0.0370).

Conclusions

RO presented a number of characteristic bone metabolic effects in the jaws that could be observed on panoramic radiographs. Radiographs of CKD patients demonstrate significantly more calcification and resorption.

Clinical relevance

The mental index, mandibular cortical index, and trabecular bone pattern are good parameters for evaluating the effects of RO on severe secondary hyperparathyroidism.

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References

  1. KDIGO (2009) Kidney disease: improving global outcomes CKD-MBD work group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 113:s1–s130

    Google Scholar 

  2. Schaefer B, Schlosser K, Wuhl E, Schall P, Klaus G, Schaefer F, Schmitt CP (2010) Long-term control of parathyroid hormone and calcium-phosphate metabolism after parathyroidectomy in children with chronic kidney disease. Nephrol Dial Transplant 25:2590–2595

    Article  PubMed  Google Scholar 

  3. Moe SM, Drueke TB, Block GA, Cannata-Andía JB, Elder GJ, Fukagawa M, Jorgetti V, Ketteler M, Lagman CB, Levin A, Macleod M, McCann L, McCulough PA, Ott SM, Wang AY, Weisinger JR, Wheeler DC (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int 76(suppl 113):S1–S130

    Google Scholar 

  4. Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, Andress DL (2007) Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 71:31–38

    Article  PubMed  Google Scholar 

  5. Hansen D, Brandi L, Rasmussen K (2009) Treatment of secondary hyperparathyroidism in hemodialysis patients: a randomized clinical trial comparing paricalcitol and alfacalcidol. BMC Nephrol 10:28

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hamouda M, Handous I, Dhia NB, Ayachi S, Letaief A, Aloui S, Frih A, Skhiri H, Khochtali H, Elmay M (2012) Brown tumors in dialyzed patients with secondary hyperparathyroidism: report of 16 cases. Hemodial Int. doi:10.1111/j.1542-4758.2012.00695.x

  7. KDIGO (2009) Clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int 76(Suppl 113):S22

    Google Scholar 

  8. Nabi Z, Algailani M, Abdelsalam M, Asaad L, Albaqumi M (2010) Regression of brown tumor of the maxilla in a patient with secondary hyperparathyroidism after a parathyroidectomy. Hemodial Int 14:247–249

    Article  PubMed  Google Scholar 

  9. Moe SM, Drueke TB (2003) Management of secondary hyperparathyroidism: the importance and the challenge of controlling parathyroid hormone levels without elevating calcium, phosphorus, and calcium-phosphorus product. Am J Nephrol 23:369–379

    Article  PubMed  Google Scholar 

  10. El-Kishawi AMW, El-Nahas AM (2006) Renal osteodystrophy: review of the disease and its treatment. Saudi J Kidney Dis Transplant 17:373–382

    Google Scholar 

  11. Ketteler M, Biggar PH (2009) Getting the balance right: assessing causes and extent of vascular calcification in chronic kidney disease. Nephrology 14:389–394

    Article  PubMed  Google Scholar 

  12. Koizumi M, Komaba H, Nakanishi S, Fujimori A, Fukagawa M (2012) Cincalcet treatment and serum FGF23 levels in hemodialysis patients with secondary hyperparathyroidism. Nephrol Dial Transplant 27:790–795

    Article  Google Scholar 

  13. Asaumi J, Aiga H, Hisatomi M, Shigehara H, Kishi K (2001) Advanced imaging in renal osteodystrophy of the oral and maxillofacial region. Dentomaxillofac Radiol 30:59–62

    Article  PubMed  Google Scholar 

  14. Antonelli JR, Hottel TL (2003) Oral manifestations of renal osteodystrophy: case report and review of the literature. Spec Care Dent 23:28–34

    Article  Google Scholar 

  15. Dutra V, Devlin H, Cristiano S, Yang J, Horner K, Fernandes ARC (2006) Mandibular morphological changes in low bone mass edentulous females: evaluation of panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:663–668

    Article  PubMed  Google Scholar 

  16. Geraets WGM, Verheij JGC, van der Stelt PF, Horner K, Lindh C, Nicopoulou-Karayianni, Jacobs R, Harrison EJ, Adams JE, Devlin H (2007) Prediction of bone mineral density with dental radiographs. Bone 40:1217–1221

    Article  PubMed  Google Scholar 

  17. Taguchi A, Tsuda M, Ohtsuka M, Kodama I, Sanada M, Nakamoto T, Inagaki K, Noguchi T, Kudo Y, Suei Y, Tanimoto K, Bollen AM (2006) Use of dental panoramic radiographs in identifying younger postmenopausal women with osteoporosis. Osteoporos Int 17:387–394

    Article  PubMed  Google Scholar 

  18. Leite AF, Figueiredo PTS, Guia CM, Melo NS, Paula AP (2010) Correlations between seven panoramic radiomorphometric índices and bone mineral density in postmenopausal women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:449–456

    Article  PubMed  Google Scholar 

  19. Verheij JGC, Geraets WG, van der Stelt PF, Horner K, Lindh C, Nicopoulou-Karayianni K, Jacobs R, Marjanovic EJ, Adams JE, Devlin H (2009) Prediction of osteoporosis with dental radiographs and age. Dentomaxillofac Radiol 38:431–437

    Article  PubMed  Google Scholar 

  20. Nackaerts O, Jacobs R, Devlin H, Pavitt S, Bleyen E, Yan B, Borghs H, Lindh C, Karayianni K, van der Stelt PF, Marjanovic E, Adams JE, Horner K (2008) Osteoporosis detection using intraoral densitometry. Dentomaxillofac Radiol 37:282–287

    Article  PubMed  Google Scholar 

  21. Bozic M, Ihan Hren N (2006) Osteoporosis and mandibles. Dentomaxillofac Radiol 35:178–184

    Article  PubMed  Google Scholar 

  22. Taguchi A, Ohtsuka M, Nakamoto T, Naito K, Tsuda M, Kudo Y, Motoyama E, Suei Y, Tanimoto K (2007) Identification of post-menopausal women at risk of osteoporosis by trained general dental practitioners using panoramic radiographs. Dentomaxillofac Radiol 36:149–154

    Article  PubMed  Google Scholar 

  23. Selvi F, Cakarer S, Tanakol R, Guler SD, Keskin C (2009) Brown tumour of the maxilla and mandible: a rare complication of tertiary hyperparathyroidism. Dentomaxillofac Radiol 38:53–58

    Article  PubMed  Google Scholar 

  24. Lindh C, Petersson A, Rohlin M (1996) Assessement of the trabecular pattern before endosseous implant treatment. Oral Surg Oral Med Oral Pathol Radiol Endod 82:335–343

    Article  Google Scholar 

  25. Ledgerton D, Horner K, Devlin H, Worthington H (1997) Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofac Radiol 26:95–100

    Article  PubMed  Google Scholar 

  26. Devlin H, Yan J (2013) Object position and imagem magnification in dental panoramic radiography: a theoretical analysis. Dentomaxillofac Radiol 42:29951683

    Article  PubMed  Google Scholar 

  27. Klemetti E, Kolmakov S, Heiskanen P, Vainio P, Lassila V (1993) Panoramic mandibular index and bone mineral densities in postmenopausal women. Oral Surg Oral Med Oral Pathol 75:774–779

    Article  PubMed  Google Scholar 

  28. Lindh C, Horner K, Jonasson G, Olsson P, Rohlin M, Jacobs R, Karayianni K, van der Stelt P, Adams J, Marjanovic E, Pavitt S, Devlin H (2008) The use of visual assessment of dental radiographs for identifying women at risk of having osteoporosis: the OSTEODENT project. Oral Surg Oral Med Oral Pathol 106:285–293

    Article  Google Scholar 

  29. Tominaga Y (2006) Surgical treatment of secondary hyperparathyroidism due to chronic kidney disease. Upsala J Med Sci 111:277–292

    Article  PubMed  Google Scholar 

  30. Ott SM (2004) Bone density in patients with chronic kidney disease stages 4–5. Nephrology 14:395–403

    Article  Google Scholar 

  31. Gulsahi A, Ozden S, Cebeci AI, Kucuk NO, Paksoy CS, Genc Y (2009) The relationship between panoramic radiomorphometric indices and the femoral bone mineral density of edentulous patients. Oral Radiol 25:47–52

    Article  Google Scholar 

  32. Devlin H, Horner K (2002) Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int 13:373–378

    Article  PubMed  Google Scholar 

  33. Michiwaki Y, Michi K, Yamaguchi A (1996) Marked enlargement of the jaws in secondary hyperparathyroidism-a case report. Int J Oral Maxillofac Surg 25:54–56

    Article  PubMed  Google Scholar 

  34. Lekholm U, Zarb GA (1985) Patient selection and preparation. In: Branemark P-I, Zarb GA, Albrektsson T (eds) Tissue-integrated prostheses: osseointegration in clinical dentistry. Quintessence Publishing Co, Chicago, pp 199–209

    Google Scholar 

  35. Resic H, Masnic F, Kukavica N, Spasovski G (2011) Unusual clinical presentation of brown tumor in hemodialysis patients: two case reports. Int Urol Nephrol 43:575–580

    Article  PubMed  Google Scholar 

  36. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klaq MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 42:1050–1065

    Article  PubMed  Google Scholar 

  37. Cardoso FNC, Yanaguizawa M, Taberner GS, Kubota ES, Fernandes ARC, Natour J (2007) Radiology contribution for the evaluation of secondary hyperparathyroidism. Rev Bras Reumatol 47:207–211

    Article  Google Scholar 

  38. Tomiyama C, Carvalho AB, Higa A, Jorgetti V, Draibe SA, Canziani ME (2010) Coronary calcification is associated with lower bone formation rate in CKD patients not yet in dialysis treatment. J Bone Miner Res 25:499–504

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank the nephrologists Dr. Januário Gonçalves Roberto, Dr. Marcus Vinicius Madureira Silva, and all the staff of Santa Casa’s hemodialysis of São José dos Campos, for allowing and supporting this study. The Paulista State University (School of Dentistry of São José dos Campos-São Paulo) and CAPES (Coordination for the improvement of higher level or education personnel) to grant the funds needed to this research became possible.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnosis and Surgery, School of Dentistry, UNESP-Univ Estadual Paulista, São José dos Campos, São Paulo, Brazil

    João César Guimarães Henriques, Julio Cezar de Melo Castilho, Rafaela Rangel Rosa & Caio Vinícius Bardi Matai

  2. Oral Imaging Center, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Leuven, Belgium

    Reinhilde Jacobs

  3. Department of Oral Diagnosis and Bioscience, School of Dentistry, UNESP-Univ Estadual Paulista, São José dos Campos, São Paulo, Brazil

    José Benedito Oliveira Amorim

  4. Disciplina de Radiologia Odontológica da Faculdade de Odontologia da Universidade Estadual Paulista “Júlio de Mesquita Filho” campus de São José dos Campos, Avenida Engenheiro Francisco José Longo, No. 777-Bairro: Jardim São Dimas, 12245-000, São Paulo, Brazil

    João César Guimarães Henriques

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  1. João César Guimarães Henriques
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Correspondence to João César Guimarães Henriques.

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Henriques, J.C.G., de Melo Castilho, J.C., Jacobs, R. et al. Severe secondary hyperparathyroidism and panoramic radiography parameters. Clin Oral Invest 18, 941–948 (2014). https://doi.org/10.1007/s00784-013-1025-0

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  • DOI: https://doi.org/10.1007/s00784-013-1025-0

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