Bone Quality Assessment as Measured by Trabecular Bone Score in Patients With End-Stage Renal Disease on Dialysis

Yavropoulou, Maria P; Vaios, Vasilios; Pikilidou, Maria; Chryssogonidis, Ioannis; Sachinidou, Melina; Tournis, Symeon; Makris, Konstantinos; Kotsa, Kalliopi; Daniilidis, M.; Haritanti, Afroditi; Liakopoulos, Vassilios

doi:10.1016/j.jocd.2016.11.002

Cited by 31 publications

(23 citation statements)

References 39 publications

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“…Bone mineral metabolism is a complex process mediated by multi-organ interactions; therefore, these various confounders, such as phosphate, calcium, vitamin D, PTH, and α-klotho may obscure the relationship between FGF 23 and bone microarchitecture. A prior study also reported that TBS was not associated with FGF 23 [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…To date, only a few studies have assessed TBS in end stage renal disease (ESRD) patients [ 16 – 20 ]. The studies have shown that TBS was significantly reduced in ESRD populations [ 17 , 19 , 20 ], and lower TBS is associated with increased prevalent or incident fracture in CKD patients [ 11 , 18 ]. However, no studies have assessed the connections between TBS and adverse clinical outcomes related to CKD-MBD in hemodialysis patients, except those studying fracture events.…”

Section: Introductionmentioning

confidence: 99%

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Trabecular bone score may indicate chronic kidney disease-mineral and bone disorder (CKD-MBD) phenotypes in hemodialysis patients: a prospective observational study

et al. 2020

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Background In the general population, the trabecular bone score (TBS) represents the bone microarchitecture and predicts fracture risk independent of bone mineral density (BMD). A few studies reported that TBS is significantly reduced in dialysis patients. Chronic kidney disease-mineral and bone disorder (CKD-MBD) are accompanied by increased fracture risk, cardiovascular morbidity, and mortality. We investigated whether TBS is associated with comorbidity related to CKD-MBD or frailty in hemodialysis patients. Methods In this prospective observational study, TBS was obtained using the TBS iNsight software program (Med-Imaps) with BMD dual energy x-ray absorptiometry (DXA) images (L1–L4) from prevalent hemodialysis patients. A Tilburg frailty indicator was used to evaluate frailty, and hand grip strength and bio-impedance (InBody) were measured. A patient-generated subjective global assessment (PG-SGA) was used for nutritional assessment. The history of cardiovascular events (CVE) and demographic, clinical, laboratory, and biomarker data were collated. We then followed up patients for the occurrence of CKD-MBD related complications. Results We enrolled 57 patients in total. The mean age was 56.8 ± 15.9 years (50.9% female). Prevalence of Diabetes mellitus (DM) was 40.4% and CVE was 36.8%. Mean TBS was 1.44 ± 0.10. TBS significantly reduced in the CVE group (1.38 ± 0.08 vs. 1.48 ± 0.10, p < 0.001). Multivariable regression analysis was conducted adjusting for age, sex, dialysis vintage, DM, CVE, albumin, intact parathyroid hormone, fibroblast growth factor 23, handgrip strength, and phosphate binder dose. Age ( ß = − 0.030; p = 0.001) and CVE ( ß = − 0.055; p = 0.024) were significant predictors of TBS. During the follow up period after TBS measurements (about 20 months), four deaths, seven incident fractures, and six new onset CVE were recorded. Lower TBS was associated with mortality ( p = 0.049) or new onset fracture ( p = 0.007, by log-rank test). Conclusion Lower TBS was independently associated with increased age and CVE prevalence in hemodialysis patients. Mortality and fracture incidence were significantly higher in patients with lower TBS values. These findings suggest that TBS may indicate a phenotype of frailty and also a CKD-MBD phenotype reciprocal to CVE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trabecular bone score may indicate chronic kidney disease-mineral and bone disorder (CKD-MBD) phenotypes in hemodialysis patients: a prospective observational study

et al. 2020

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“…The wide range of TBS values in patients with reduced kidney function ( 32 ), on hemodialysis ( 36 , 37 ) and kidney transplant recipients ( 38 – 43 ) does not allow us to speculate on an association between the deterioration of renal function and decline in TBS. Nevertheless, the results of the studies reported in this review cannot be compared due to the differences in characteristics, such as age or body mass index, and the DXA devices used in the studied populations.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with ESRD on hemodialysis, TBS suggests that a significant deterioration of bone quality might be present, independent of bone mass and other biochemical changes in ESRD, postulating itself as a valuable marker in assessing bone quality in these patients ( 36 , 37 ). Nevertheless, the small sample sizes of the current studies on this topic, could not allow the full investigation of TBS predictive value in the risk of fragility fractures.…”

Section: Discussionmentioning

confidence: 99%

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Review on the Utility of Trabecular Bone Score, a Surrogate of Bone Micro-architecture, in the Chronic Kidney Disease Spectrum and in Kidney Transplant Recipients

2018

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Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for >3 months, with implications for, among others, bone health. Advanced stages of CKD have an increased risk of fragility fractures. Trabecular bone score (TBS) is a relatively new gray-level textural parameter, which provides information on bone microarchitecture and has been shown to be a good predictor of fragility fractures independently of bone density and clinical risk factors. We aimed to review the scientific literature on TBS and its utility along the CKD spectrum and in kidney transplant recipients. In total, eight articles had investigated this topic: one article in patients with reduced kidney function, two in patients on hemodialysis, and five in kidney transplant recipients. In general, all the studies had shown an association between lower values of TBS and reduced kidney function; or lower TBS values among the hemodialysis or kidney transplant patients compared to healthy controls. Moreover, TBS was shown to be a good and independent predictor of fragility fractures in patients with CKD or who underwent kidney transplantation. TBS postulates itself as a valuable marker to be used in clinical practice as an assessor of bone microarchitecture and fracture risk predictor in these specific populations. However, evidence is to some extent limited and larger follow-up case-control studies would help to further investigate the TBS utility in the management of bone health damage and increased fracture risk in patients with CKD or kidney transplant.

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New Imaging Techniques for Bone

Ramchand

Tsai

2020

Osteoporosis

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Bone Quality Assessment as Measured by Trabecular Bone Score in Patients With End-Stage Renal Disease on Dialysis

Cited by 31 publications

References 39 publications

Trabecular bone score may indicate chronic kidney disease-mineral and bone disorder (CKD-MBD) phenotypes in hemodialysis patients: a prospective observational study

Trabecular bone score may indicate chronic kidney disease-mineral and bone disorder (CKD-MBD) phenotypes in hemodialysis patients: a prospective observational study

Review on the Utility of Trabecular Bone Score, a Surrogate of Bone Micro-architecture, in the Chronic Kidney Disease Spectrum and in Kidney Transplant Recipients

New Imaging Techniques for Bone

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