Advertisement

Archives of Osteoporosis

, 13:125 | Cite as

Chronic hemodialysis is associated with lower trabecular bone score, independent of bone mineral density: a case-control study

  • Roxana Dusceac
  • Dan Alexandru NiculescuEmail author
  • Ramona Dobre
  • Madalina Cristina Dragne
  • Catalin Tacu
  • Ileana Peride
  • Cristiana David
  • Ionel Checherita
  • Catalina Poiana
Original Article
  • 60 Downloads

Abstract

Summary

We measured trabecular bone score (TBS) in 98 patients on permanent hemodialysis (HD) and 98 subjects with similar bone mineral density and normal kidney function. TBS was significantly lower in HD patients, indicating deteriorated bone microarchitecture, independent of bone mass. This might partially explain the increased fracture risk in HD.

Purpose

In the general population, trabecular bone score (TBS) was shown to predict fracture independent of bone mineral density (BMD). In end-stage renal disease patients on hemodialysis (HD), the value of TBS is beyond that of BMD in currently unclear. Our aim was to assess lumbar spine (LS) TBS in HD patients compared with subjects with normal kidney function matched for age, sex, and LS BMD.

Methods

We assessed TBS and LS and femoral neck (FN) BMD in 98 patient on permanent HD (42.8% males; mean age 57.5 ± 11.3 years; dialysis vintage 5.5 ± 3.8 years) and 98 control subjects (glomerular filtration rate > 60 mL/min) using DXA. We simultaneously controlled for sex, age (± 3 years), and LS BMD (± 0.03 g/cm2).

Results

HD patients had significantly lower LS TBS (0.07 [95% CI 0.03–0.1]; p = 0.0004), TBS T-score (0.83 SD [95% CI 0.42–1.24]; p = 0.0001)) and TBS Z-score (0.81 SD [95% CI 0.41–1.20]; p = 0.0001) than matched controls. TBS significantly correlated with LS BMD in both HD patients (r = 0.382; p = 0.001) and controls (r = 0.36; p = 0.002). The two regression lines had similar slopes (0.3 vs. 0.28; p = 0.84) with different intercepts (0.88 vs. 0.98). TBS adjustment significantly increased the 10-year fracture risk from 3.7 to 5.3 for major osteoporotic fracture and from 0.9 to 1.5 for hip fracture.

Conclusions

HD patients have lower TBS than controls matched for LS BMD, indicating altered bone microarchitecture. Also, the magnitude of TBS reduction in HD patients is constant at any LS BMD. Adjustment for TBS partially corrects the absolute 10-year fracture risk.

Keywords

Trabecular bone score Bone mineral density End-stage renal disease Fracture risk 

Notes

Acknowledgements

We would like to thank Mrs. Gabriela Voicu and Mr. Morell Stoiceanu for their support with the DXA scans.

Compliance with ethical standards

The study was approved by the Institutional Ethic Committee. All patients signed an informed consent.

Conflicts of interest

None.

References

  1. 1.
    Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399.  https://doi.org/10.1046/j.1523-1755.2000.00178.x CrossRefPubMedGoogle Scholar
  2. 2.
    Rodriguez-Garcia M, Gomez-Alonso C, Naves-Diaz M, Diaz-Lopez JB, Diaz-Corte C, Cannata-Andia JB, the Asturias Study Group (2008) Vascular calcifications, vertebral fractures and mortality in haemodialysis patients. Nephrol Dial Transplant 24:239–246.  https://doi.org/10.1093/ndt/gfn466 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fusaro M, Tripepi G, Noale M, Vajente N, Plebani M, Zaninotto M, Guglielmi G, Miotto D, Carbonare LD, D’Angelo A, Ciurlino D, Puggia R, Miozzo D, Giannini S, Gallieni M (2013) High prevalence of vertebral fractures assessed by quantitative morphometry in hemodialysis patients, strongly associated with vascular calcifications. Calcif Tissue Int 93:39–47.  https://doi.org/10.1007/s00223-013-9722-x CrossRefPubMedGoogle Scholar
  4. 4.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739.  https://doi.org/10.1359/jbmr.2000.15.4.721 CrossRefPubMedGoogle Scholar
  5. 5.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397.  https://doi.org/10.1007/s00198-007-0543-5 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Jamal SA, Hayden JA, Beyene J (2007) Low bone mineral density and fractures in long-term hemodialysis patients: a meta-analysis. Am J Kidney Dis 49:674–681.  https://doi.org/10.1053/j.ajkd.2007.02.264 CrossRefPubMedGoogle Scholar
  7. 7.
    Pothuaud L, Carceller P, Hans D (2008) Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture. Bone 42:775–787.  https://doi.org/10.1016/j.bone.2007.11.018 CrossRefPubMedGoogle Scholar
  8. 8.
    Bousson V, Bergot C, Sutter B et al (2012) Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects. Osteoporos Int 23:1489–1501.  https://doi.org/10.1007/s00198-011-1824-6 CrossRefPubMedGoogle Scholar
  9. 9.
    Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP (2014) Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res 29:518–530.  https://doi.org/10.1002/jbmr.2176 CrossRefPubMedGoogle Scholar
  10. 10.
    Leslie WD, Shevroja E, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Hans D (2018) Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry. Osteoporos Int 29:751–758.  https://doi.org/10.1007/s00198-018-4405-0 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Yavropoulou MP, Vaios V, Pikilidou M, Chryssogonidis I, Sachinidou M, Tournis S, Makris K, Kotsa K, Daniilidis M, Haritanti A, Liakopoulos V (2017) Bone quality assessment as measured by trabecular bone score in patients with end-stage renal disease on dialysis. J Clin Densitom 20:490–497.  https://doi.org/10.1016/j.jocd.2016.11.002 CrossRefPubMedGoogle Scholar
  12. 12.
    Brunerová L, Ronová P, Verešová J, Beranová P, Potoèková J, Kasalický P, Rychlík I (2016) Osteoporosis and impaired trabecular bone score in hemodialysis patients. Kidney Blood Press Res 41:345–354.  https://doi.org/10.1159/000443439 CrossRefPubMedGoogle Scholar
  13. 13.
    Luckman M, Hans D, Cortez N, Nishiyama KK, Agarawal S, Zhang C, Nikkel L, Iyer S, Fusaro M, Guo EX, McMahon DJ, Shane E, Nickolas TL (2017) Spine trabecular bone score as an indicator of bone microarchitecture at the peripheral skeleton in kidney transplant recipients. Clin J Am Soc Nephrol 12:644–652.  https://doi.org/10.2215/CJN.09850916 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Aleksova J, Kurniawan S, Elder GJ (2018) The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease. Osteoporos Int 29:1447–1455.  https://doi.org/10.1007/s00198-018-4468-y CrossRefPubMedGoogle Scholar
  15. 15.
    Tucci JR, Tonino RP, Emkey RD, Peverly CA, Kher U, Santora AC II (1996) Effect of three years of oral alendronate treatment in postmenopausal women with osteoporosis. Am J Med 101:488–501CrossRefGoogle Scholar
  16. 16.
    Urena P (2003) Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 18:2325–2331.  https://doi.org/10.1093/ndt/gfg403 CrossRefPubMedGoogle Scholar
  17. 17.
    Huang G-S, Chu T-S, Lou M-F, Hwang SL, Yang RS (2009) Factors associated with low bone mass in the hemodialysis patients--a cross-sectional correlation study. BMC Musculoskelet Disord 10(60).  https://doi.org/10.1186/1471-2474-10-60
  18. 18.
    Malluche HH, Porter DS, Pienkowski D (2013) Evaluating bone quality in patients with chronic kidney disease. Nat Rev Nephrol 9:671–680.  https://doi.org/10.1038/nrneph.2013.198 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    David C, Bover J, Voiculet C, Peride I, Petcu LC, Niculae A, Covic A, Checherita IA (2017) Coronary risk score for mineral bone disease in chronic non-diabetic hemodialysis patients: results from a prospective pilot study. Int Urol Nephrol 49:689–700.  https://doi.org/10.1007/s11255-016-1481-y CrossRefPubMedGoogle Scholar
  20. 20.
    Checheriţă IA, Smarandache D, David C et al (2012) Vascular calcifications in chronic kidney disease--clinical management. Romanian J Morphol Embryol 53:7–13Google Scholar
  21. 21.
    Kolta S, Briot K, Fechtenbaum J, Paternotte S, Armbrecht G, Felsenberg D, Glüer CC, Eastell R, Roux C (2014) TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int 25:1759–1764.  https://doi.org/10.1007/s00198-014-2685-6 CrossRefPubMedGoogle Scholar
  22. 22.
    Formica C, Atkinson MG, Nyulasi I, McKay J, Heale W, Seeman E (1993) Body composition following hemodialysis: studies using dual-energy X-ray absorptiometry and bioelectrical impedance analysis. Osteoporos Int 3:192–197CrossRefGoogle Scholar
  23. 23.
    Kim K-N, Kim B-T, Kim K-M, Park SB, Joo NS, Je SH, Kim YS, Lee DJ (2012) The influence of exogenous fat and water on lumbar spine bone mineral density in healthy volunteers. Yonsei Med J 53:289–293.  https://doi.org/10.3349/ymj.2012.53.2.289 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Wakasugi M, Kazama JJ, Wada A, Hamano T, Masakane I, Narita I (2018) Hip fracture trends in Japanese dialysis patients, 2008-2013. Am J Kidney Dis 71:173–181.  https://doi.org/10.1053/j.ajkd.2017.07.017 CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Roxana Dusceac
    • 1
  • Dan Alexandru Niculescu
    • 1
    Email author
  • Ramona Dobre
    • 1
  • Madalina Cristina Dragne
    • 1
  • Catalin Tacu
    • 2
  • Ileana Peride
    • 3
  • Cristiana David
    • 3
  • Ionel Checherita
    • 3
  • Catalina Poiana
    • 1
  1. 1.Department of EndocrinologyCarol Davila University of Medicine and PharmacyBucharestRomania
  2. 2.Diaverum Dialysis CenterBucharestRomania
  3. 3.Department of NephrologyCarol Davila University of Medicine and PharmacyBucharestRomania

Personalised recommendations