Bone mineral density by DXA and HR pQCT can discriminate fracture status in men and women with stages 3 to 5 chronic kidney disease
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Fractures are common in chronic kidney disease (CKD). We determined if bone mineral density testing by dual energy X-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HR pQCT) could discriminate fracture status in CKD patients. Both tests were able to discriminate fracture status. Further, the addition of HR pQCT measurements to DXA measurements did not improve fracture discrimination.
The optimal method to identify individuals with CKD at high fracture risk is unknown.
We determined if bone mineral density (BMD) by DXA and HR pQCT could discriminate fracture status in 211 adult men and women with stages 3 to 5 CKD, attending predialysis clinics in Toronto Canada, using logistic regression. Results are expressed as the odds ratio (OR) of fracture (prevalent vertebral and/or low trauma since age 40 years) per standard deviation decrease in the predictor adjusted for age, weight, sex, and CKD stage. We constructed receiver operating characteristic curves to examine the discriminative ability of BMD measures for fracture.
Most participants were Caucasian men with a mean age of 63.3 ± 15.5 years. There were 77 fractures in 74 participants. Decreases in BMD were associated with increased fracture risk: OR = 1.56 (95% confidence interval (CI), 1.41 to 1.71) for BMD by DXA at the ultradistal radius, and OR = 1.24 (95% CI, 1.12 to 1.36) for cortical area by HR pQCT. Further, while both tests were able to discriminate fracture status, the addition of HR pQCT measures to BMD by DXA did not improve fracture discrimination ability.
Among CKD patients not yet requiring renal replacement therapy, BMD by DXA is able to discriminate fracture status.
KeywordsBone mineral density Chronic kidney disease Fractures Risk factors for fracture
The authors would like to thank Paul Miller for his careful review of this manuscript. Funding was provided by the Canadian Institutes of Health Research (FRN: 93785), the Physicians Services Incorporated Foundation, and The Kidney Foundation of Canada. Some results of this study were presented in abstract format at the 2010 ASN Renal Week and in abstract format at the 2010 and 2011 American Society for Bone and Mineral Research Annual Meeting.
Conflicts of interest
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