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Is dual-energy absorptiometry accurate in the assessment of bone status of patients with chronic kidney disease?

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A Correction to this article was published on 26 June 2023

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Abstract

Summary

Several patients with chronic kidney disease (CKD) have deteriorated bone status. Estimation of bone status using DXA has limitations especially in patients with CKD accompanying aortic calcifications. Quantitative CT and the trabecular bone score could be more accurate methods to estimate bone status for patients with CKD and vascular calcifications.

Introduction

It remains unclear whether dual-energy absorptiometry (DXA) is appropriate for the assessment of bone status in patients with chronic kidney disease (CKD), a disease that impacts bone health. The aims of this study were to compare DXA and central quantitative computed tomography (cQCT) and to evaluate bone status in patients with pre-dialysis CKD.

Methods

This retrospective study included 363 healthy control subjects whose bone mineral density (BMD) was evaluated with DXA and 117 CKD patients whose BMD was evaluated using both cQCT and DXA. Diagnostic discordance was assessed between the lumbar spine (LS) and femur neck (FN) from DXA or between two modalities. The trabecular bone score (TBS) was extracted from DXA images. The volume of abdominal aortic calcification (AAC) was calculated using CT images from cQCT.

Results

Using LS DXA T-score, osteoporosis was less common in the CKD group than in controls. Patients with normal LS BMD using DXA were reclassified into osteopenia or osteoporosis using cQCT in CKD patients. Among discordant subjects between FN and LS in DXA, a higher BMD of LS was more common in CKD patients than in controls. CKD patients had lower TBS than controls despite having the same diagnosis using DXA. AAC volume negatively correlated with BMD from cQCT and with TBS but not with BMD from DXA.

Conclusions

TBS and cQCT could accurately assess bone status in CKD patients since DXA may overestimate LS BMD, likely due to an increased AAC volume.

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Acknowledgments

We appreciate the Department of Nuclear Medicine for the kind cooperation in the further evaluation of the patients.

Funding

This study has received funding by the Biomedical Research Institute Grant of Pusan National University Hospital (2018B025).

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Authors and Affiliations

  1. Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Busan, Republic of Korea

    K. Kim & I.-J. Kim

  2. Division of Nephrology, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea

    S.H. Song

  3. Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Gudeok-ro 179, Seo-gu, Busan, 602-739, South Korea

    I.-J. Kim & Y.K. Jeon

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Correspondence to Y.K. Jeon.

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This retrospective study was approved by our institutional review board, and the requirement for written consent was waived (IRB No. H-1906-004-079).

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The original online version of this article was revised: The affiliation details for Author K. Kim were incorrectly given as 'Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.' but should have been 'Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Busan, Republic of Korea'.

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Kim, K., Song, S., Kim, IJ. et al. Is dual-energy absorptiometry accurate in the assessment of bone status of patients with chronic kidney disease?. Osteoporos Int 32, 1859–1868 (2021). https://doi.org/10.1007/s00198-020-05670-z

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