Cortical PQCT Measures Are Associated With Fractures in Dialysis Patients

Jamal, Sophie A.; Gilbert, Jeremy; Gordon, Christopher L.; Bauer, Douglas C.

doi:10.1359/jbmr.060105

Cited by 162 publications

(135 citation statements)

References 31 publications

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“…The authors describe a general reduction of cortical volumetric bone mineral density (vBMD), stable trabecular vBMD, and a significant relationship between bone loss and dialysis vintage. With pQCT, a significant association with fracture was found for lower Dcort and CtTh, but not for Dtrab or DXA measurements at the lumbar spine and femur (8). An important finding reported here is that poor trabecular microarchitecture is associated with bone fractures in dialysis patients.…”

Section: Discussioncontrasting

confidence: 41%

“…pQCT, which does not permit assessment of trabecular microarchitecture, has been used previously in hemodialysis patients (8,16,17). The authors describe a general reduction of cortical volumetric bone mineral density (vBMD), stable trabecular vBMD, and a significant relationship between bone loss and dialysis vintage.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, vascular calcification, which is common in dialysis patients, may substantially contribute to BMD values measured with DXA (7). Quantification of cortical density, area, or thickness by peripheral quantitative computed tomography (pQCT) is more closely associated with bone fractures in this population (8). Despite the effective discrimination between cortical and trabecular density, pQCT is unable to depict trabecular microarchitecture.…”

Section: Introductionmentioning

confidence: 99%

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Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Cejka

Patsch²,

Weber³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Dialysis patients are at high risk for low-trauma bone fracture. Bone density measurements using dual-energy x-ray absorptiometry (DXA) do not reliably differentiate between patients with and without fractures. The aim of this study was to identify differences in bone microarchitecture between patients with and without a history of fracture using high-resolution peripheral quantitative computed tomography (HR-pQCT).Design, setting, participants, & measurements Seventy-four prevalent hemodialysis patients were recruited for measurements of areal bone mineral density (aBMD) by DXA and bone microarchitecture by HR-pQCT. Patients with a history of trauma-related fracture were excluded. Forty healthy volunteers served as controls. Blood levels of parathyroid hormone, vitamin D, and markers of bone turnover were determined.Results Dialysis patients, particularly women, had markedly impaired bone microarchitecture. Patients with fractures had significantly reduced cortical and trabecular microarchitecture compared with patients without fractures. aBMD tended to be lower in patients with fractures, but differences were statistically not significant. The strongest determinant of fracture was the HR-pQCT-measured trabecular density of the tibia, which also had the highest discriminatory power to differentiate patients according to fracture status. Radial DXA had a lower discriminatory power than trabecular density. ConclusionsBone microarchitecture is severely impaired in dialysis patients and even more so in patients with a history of fracture. HR-pQCT can identify dialysis patients with a history of low-trauma fracture.

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Cejka

Patsch²,

Weber³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…A recent cross-sectional ROC study in 52 adults on maintenance hemodialysis demonstrated that reductions in pQCT measures of cortical bone in the radius were strongly predictive of vertebral and fragility fractures, whereas pQCT trabecular vBMD and DXA areal BMD were not [59]. Table 2 illustrates the marked differences in the odds of fracture and AUC at each site.…”

Section: Dxa and Pqct Receiver Operating Characteristic Curves In Ckdmentioning

confidence: 99%

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Leonard

2007

Pediatr Nephrol

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Children with chronic kidney disease (CKD) have multiple risk factors for impaired accretion of trabecular and cortical bone. CKD during childhood poses an immediate fracture risk and compromises adult bone mass, resulting in significantly greater skeletal fragility throughout life. Highturnover disease initially results in thickened trabeculae, with greater bone volume. As disease progresses, resorption cavities dissect trabeculae, connectivity degrades, and bone volume decreases. Increased bone turnover also results in increased cortical porosity and decreased cortical thickness. Dual-energy X-ray absorptiometry (DXA)-based measures of bone mineral density (BMD) are derived from the total bone mass within the projected bone area (g/cm 2 ), concealing distinct disease effects in trabecular and cortical bone. In contrast, peripheral quantitative computed tomography (pQCT) estimates volumetric BMD (vBMD, g/cm 3 ), distinguishes between cortical and trabecular bone, and provides accurate estimates of cortical dimensions. Recent data have confirmed that pQCT measures of cortical vBMD and thickness provide substantially greater fracture discrimination in adult dialysis patients compared with hip or spine DXA. The following review considers the structural effects of renal osteodystrophy as it relates to fracture risk and the potential advantages and disadvantages of DXA and alternative measures of bone density, geometry, and microarchitecture, such as pQCT, micro-CT (μCT), and micro magnetic resonance imaging (μMRI) for fracture risk assessment.

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“…The loss of bone structural integrity could also be explained by lead's activation of the peroxisome proliferator-activated receptor (PPAR)-γ pathway, leading to preferential differentiation of mesenchymal stem cells to adipocytes rather than to osteocytes [26]. Cortical thickness was the primary variable that showed any effect due to bone lead, and is also one of the most clinically impacted structural outcomes previously reported to relate directly to fracture risk [27,28]. Trabecular bone exhibits a higher turnover than cortical bone.…”

Section: Discussionmentioning

confidence: 99%

Bone lead (Pb) content at the tibia is associated with thinner distal tibia cortices and lower volumetric bone density in postmenopausal women

Wong

Beattie

Bhargava

et al. 2015

Bone

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Conflicting evidence suggests that bone lead or blood lead may reduce areal bone mineral density (BMD). Little is known about how lead at either compartment affects bone structure. This study examined postmenopausal women (N = 38, mean age 76 ± 8, body mass index (BMI): 26.74 ± 4.26 kg/m 2 ) within the Hamilton cohort of the Canadian Multicentre Osteoporosis Study (CaMos), measuring bone lead at 66% of the non-dominant leg and at the calcaneus using 109 Cadmium X-ray fluorescence. Volumetric BMD and structural parameters were obtained from peripheral quantitative computed tomography images (200 μm in-plane resolution, 2.3 ± 0.5 mm slice thickness) of the same 66% site and of the distal 4% site of the tibia length. Blood lead was measured using atomic absorption spectrometry and blood-to-bone lead partition coefficients (P BB , log ratio) were computed. Multivariable linear regression examined each of bone lead at the 66% tibia, calcaneus, blood lead and P BB as related to each of volumetric BMD and structural parameters, adjusting for age and BMI, diabetes or antiresorptive therapy. Regression coefficients were reported along with 95% confidence intervals. Higher amounts of bone lead at the tibia were associated with thinner distal tibia cortices (−0.972 (−1.882, −0.061) per 100 μg Pb/g of bone mineral) and integral volumetric BMD (−3.05 (−6.05, −0.05) per μg Pb/g of bone mineral). A higher P BB was associated with larger trabecular separation (0.115 (0.053, 0.178)), lower trabecular volumetric BMD (−26.83 (−50.37, −3.29)) and trabecular number (−0.08 (−0.14, −0.02)), per 100 μg Pb/g of bone mineral after adjusting for age and BMI, and remained significant while accounting for diabetes or use of antiresorptives. Total lead exposure activities 8.29 (0.11, 16.48)) and remained significant after age and antiresorptives-adjustment. Lead accumulated in bone can have a mild insult on bone structure; but greater partitioning of lead in blood versus bone revealed more dramatic effects on both microstructure and volumetric BMD.

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Cortical PQCT Measures Are Associated With Fractures in Dialysis Patients

Cited by 162 publications

References 31 publications

Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Bone lead (Pb) content at the tibia is associated with thinner distal tibia cortices and lower volumetric bone density in postmenopausal women

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