Bone mineral density by DXA and HR pQCT can discriminate fracture status in men and women with stages 3 to 5 chronic kidney disease

Jamal, Sophie A.; Cheung, Angela M.; West, Sarah; Lok, Charmaine E.

doi:10.1007/s00198-012-1908-y

Cited by 79 publications

(92 citation statements)

References 28 publications

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“…(5) The current study reports longitudinal data in a subgroup of these same subjects followed for 2 years (n ¼ 131).…”

Section: Methodsmentioning

confidence: 99%

“…(5,8,9) We collected data on demographics and the presence of risk factors for fractures. We also telephoned subjects every 4 months to inquire about: incident falls and fractures, changes in prescription medication, and changes to health status.…”

Section: Interviewer-administered Questionnairementioning

confidence: 99%

“…(5,11) Incident morphometric spine fractures were identified by comparing films at baseline and at 2-year follow-up and were defined as a change in semiquantitative grade of at least one. Two radiologists, blinded to the clinical history and results of BMD testing, reviewed all spine radiographs…”

Section: Fracturesmentioning

confidence: 99%

“…Measurements were obtained at the nondominant distal radius by trained technologists blinded to the study hypotheses, not involved in patient care, and according to the manufacturer's standard protocol. (5) We included HRpQCT measures that we have found to be associated with fractures in subjects with CKD. (5) Measurements included: total volumetric BMD, cortical area, trabecular area, cortical density, cortical thickness, trabecular density, trabecular thickness, and trabecular separation.…”

Section: Hrpqctmentioning

confidence: 99%

“…(5) We included HRpQCT measures that we have found to be associated with fractures in subjects with CKD. (5) Measurements included: total volumetric BMD, cortical area, trabecular area, cortical density, cortical thickness, trabecular density, trabecular thickness, and trabecular separation. The reproducibility (root-mean-square coefficient of variation) for measurements at the distal radius ranges from 0.46% to 0.70%.…”

Section: Hrpqctmentioning

confidence: 99%

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Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

West

Lok

Langsetmo

et al. 2014

Journal of Bone and Mineral Research

168

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Fractures are common in chronic kidney disease (CKD). The optimal methods by which to assess fracture risk are unknown, in part, due to a lack of prospective studies. We determined if bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and/ or high-resolution peripheral quantitative computed tomography (HRpQCT) could predict fractures in men and women !18 years old with stages 3 to 5 CKD. BMD was measured by DXA (at the total hip, lumbar spine, ultradistal, and 1/3 radius) and by HRpQCT (at the radius), and subjects were followed for 2 years for incident morphometric spine fractures and low-trauma clinical fractures. The mean age of the subjects was 62 years with equal numbers having stages 3, 4, and 5 CKD. Over 2 years there were 51 fractures in 35 subjects. BMD by DXA at baseline was significantly lower at all sites among those with incident fractures versus those without. For example, the mean BMD at the total hip in those with incident fractures was 0.77 g/cm 2 (95% confidence interval [CI], 0.73 to 0.80) and in those without fracture was 0.95 g/cm 2 (95% CI, 0.92 to 0.98). Almost all baseline HRpQCT measures were lower in those with incident fracture versus those without. For example, volumetric BMD in those with incident fractures was 232 mg HA/cm 3 (95% CI, 213 to 251) and in those without fracture was 317.6 mg HA/cm 3 (95% CI, 306 to 329.1). Bone loss occurred in all subjects, but was significantly greater among those with incident fractures. Our data demonstrate that low BMD (by DXA and HRpQCT) and a greater annualized percent decrease in BMD are risk factors for subsequent fracture in men and women with predialysis CKD.

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“…(5) The current study reports longitudinal data in a subgroup of these same subjects followed for 2 years (n ¼ 131).…”

Section: Methodsmentioning

confidence: 99%

Section: Interviewer-administered Questionnairementioning

confidence: 99%

Section: Fracturesmentioning

confidence: 99%

Section: Hrpqctmentioning

confidence: 99%

Section: Hrpqctmentioning

confidence: 99%

See 3 more Smart Citations

Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

West

Lok

Langsetmo

et al. 2014

Journal of Bone and Mineral Research

168

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Rethinking Bone Disease in Kidney Disease

Damasiewicz

Nickolas

2018

JBMR Plus

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Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD‐MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population. Furthermore, at a population level, fractures are at historically high levels in patients with end‐stage kidney disease (ESKD), whereas in contrast the general population has experienced a steady decline in fracture incidence rates. Based on these findings, it is clear that a paradigm shift is needed in our approach to diagnosing and managing ROD. In clinical practice, our ability to diagnose ROD and initiate antifracture treatments is impeded by the lack of accurate noninvasive methods that identify ROD type. The past decade has seen advances in the noninvasive measurement of bone quality and strength that have been studied in kidney disease patients. Below we review the current literature pertaining to the epidemiology, pathology, diagnosis, and management of ROD. We aim to highlight the pressing need for a greater awareness of this condition and the need for the implementation of strategies that prevent fractures in kidney disease patients. Research is needed for more accurate noninvasive assessment of ROD type, clinical studies of existing osteoporosis therapies in patients across the spectrum of kidney disease, and the development of CKD‐specific treatments. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Rapid cortical bone loss in patients with chronic kidney disease

Nickolas

Stein

Dworakowski

et al. 2013

Journal of Bone and Mineral Research

269

247

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Chronic kidney disease (CKD) patients may have high rates of bone loss and fractures, but microarchitectural and biochemical mechanisms of bone loss in CKD patients have not been fully described. In this longitudinal study of 53 patients with CKD Stages 2-5D, we used dual energy X-ray absorptiometry (DXA), high resolution peripheral quantitative computed tomography (HRpQCT) and biochemical markers of bone metabolism to elucidate effects of CKD on the skeleton. Median follow-up was 1.5 years (Range 0.9 to 4.3 years); bone changes were annualized and compared to baseline. By DXA, there were significant declines in areal bone mineral density (BMD) of the total hip and ultradistal radius: −1.3% (95% CI: −2.1 to −0.6) and −2.4% (95% CI: −4.0 to −0.9), respectively. By HRpQCT at the distal radius, there were significant declines in cortical area, density and thickness, and increases in porosity: −2.9% (95% CI −3.7 to −2.2), −1.3% (95% CI −1.6 to −0.6), −2.8% (95% CI −3.6 to −1.9), and +4.2% (95% CI 2.0 to 6.4) respectively. Radius trabecular area increased significantly: +0.4% (95% CI 0.2 to 0.6), without significant changes in trabecular density or microarchitecture. Elevated time-averaged levels of parathyroid hormone (PTH) and bone turnover markers predicted cortical deterioration. Higher levels of serum 25-hydroxyvitamin D predicted decreases in trabecular network heterogeneity. These data suggest that significant cortical loss occurs with CKD, which is mediated by hyperparathyroidism and elevated turnover. Future investigations are required to determine whether these cortical losses can be attenuated by treatments that reduce PTH levels and remodeling rates.

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Bone mineral density by DXA and HR pQCT can discriminate fracture status in men and women with stages 3 to 5 chronic kidney disease

Abstract: Among CKD patients not yet requiring renal replacement therapy, BMD by DXA is able to discriminate fracture status.

Cited by 79 publications

References 28 publications

Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

Retracted: Bone Mineral Density Predicts Fractures in Chronic Kidney Disease

Rethinking Bone Disease in Kidney Disease

Rapid cortical bone loss in patients with chronic kidney disease

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