Nakagawa Y, Komaba H, Hamano N, et al. - According to this cross-sectional and prospective cohort study, sclerostin has a limited role in bone metabolism in dialysis patients and may not mediate the effect of parathyroid hormone (PTH) on bone turnover.

• The study included 654 patients undergoing hemodialysis at 10 different facilities in Japan.

• Hemodialysis patients had a median sclerostin level that was 3–4 times higher than healthy people.

• Higher levels of sclerostin were linked to higher metacarpal BMD and lower levels of intact PTH, bone alkaline phosphatase, and tartrate-resistant acid phosphatase-5b.

• However, after controlling for PTH, the relationships between sclerostin and bone turnover markers were significantly reduced.

• As per the results of the mediation analysis, the effects of PTH on bone turnover markers were primarily direct rather than mediated by sclerostin.

• Sclerostin levels were found to be unrelated to previous or incident fractures.