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Trabecular bone score in patients with chronic kidney disease

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Abstract

Summary

Patients with chronic kidney disease have high risk of osteoporotic fractures. Lower trabecular bone score (TBS) was associated with poorer kidney function and higher fracture risk when kidney function was normal. Addition of TBS to The Fracture Risk Assessment Tool with bone mineral density did not improve fracture risk prediction.

Introduction

We sought to determine whether trabecular bone score (TBS) either independently or adjusted for The Fracture Risk Assessment Tool (FRAX) could predict risk of major osteoporotic fractures (MOFs) in a large population-based sample of patients with all stages of chronic kidney disease (CKD).

Methods

We used population-based administrative databases to identify patients above age 20 years who had dual-energy X-ray absorptiometry (DXA) scan and serum creatinine measured within 1 year, during the years 2005 to 2010. Patients were excluded if they were on dialysis or had a functioning renal transplant. We stratified patients by estimated glomerular filtration rate (eGFR). We collected femoral neck bone mineral density (BMD), lumbar spine TBS, incident major osteoporotic fractures (MOF) and hip fractures, and other clinical characteristics.

Results

Among 8289 patients, there were 6224 (75.1%) with eGFR ≥ 60 mL/min/1.73 m2, 1624 (19.6%) with eGFR 30–60 mL/min/1.73 m2, and 441 (5.3%) with eGFR < 30 mL/min/1.73 m2. There were 593 patients (7.2%) with MOFs and 163 (2.0%) with hip fractures. Lower TBS score was associated with increased risk of MOF and hip fractures across all eGFR strata in unadjusted Cox proportional hazards models but after adjusting for FRAX with BMD, lower TBS was only statistically significant for MOF prediction for eGFR ≥ 60 mL/min/1.73 m2.

Conclusion

Lower TBS scores were associated with lower eGFR and increased fracture risk in patients with eGFR ≥ 60 mL/min/1.73 m2. However, the addition of TBS to the FRAX score with BMD did not significantly improve fracture risk prediction in patients with CKD.

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Article Open access 01 July 2023

Enisa Shevroja, Jean-Yves Reginster, … Nicholas C. Harvey

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Acknowledgments

Data used in this study are from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba and were derived from data provided by Manitoba Health, Winnipeg Regional Health Authority and Diagnostic Services Manitoba. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. All authors contributed to review of data results and drafting of the manuscript.

Funding

This work was supported through funding provided by the Department of Health of the Province of Manitoba to the University of Manitoba (HIPC# 2015/2016-12). The results and conclusions are those of the authors and no official endorsement by Manitoba Health was intended or should be inferred.

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Authors and Affiliations

  1. Rady Faculty of Health Sciences, University of Manitoba, GF324–820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada

    C. Rampersad, R. H. Whitlock, W. D. Leslie, C. Rigatto, P. Komenda, C. Bohm & N. Tangri

  2. Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada

    R. H. Whitlock, C. Rigatto, P. Komenda, C. Bohm & N. Tangri

  3. Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    D. Hans

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Correspondence to C. Rampersad.

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Conflicts of interest

Dr. Hans is a co-owner of the TBS patent and holds stock options and royalties in the Medimaps group. Dr. Tangri reports grants and personal fees from Astra Zeneca Inc, personal fees from Otsuka Inc, personal fees from Janssen, personal fees from Boehringer Ingelheim/Eli LIlly, grants, personal fees and other from Tricida Inc, outside the submitted work.

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Rampersad, C., Whitlock, R.H., Leslie, W.D. et al. Trabecular bone score in patients with chronic kidney disease. Osteoporos Int 31, 1905–1912 (2020). https://doi.org/10.1007/s00198-020-05458-1

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