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Clin J Am Soc Nephrol. 2017 Apr 3;12(4):644-652. doi: 10.2215/CJN.09850916. Epub 2017 Mar 27.

Spine Trabecular Bone Score as an Indicator of Bone Microarchitecture at the Peripheral Skeleton in Kidney Transplant Recipients.

Author information

1
Institute of Human Nutrition and Departments of.
2
Center of Bone Diseases, Bone and Joint Department, Medical University of Lausanne, Lausanne, Switzerland.
3
Medicine and.
4
Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York.
5
Department of Medicine, Kaiser Oakland Medical Center, Oakland, California; and.
6
Institute of Clinical Physiology, National Research Council, Pisa, Italy.
7
Biomedical Engineering, Columbia University, New York, New York.
8
Medicine and tln2001@cumc.columbia.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Studies using high-resolution peripheral quantitative computed tomography showed progressive abnormalities in cortical and trabecular microarchitecture and biomechanical competence over the first year after kidney transplantation. However, high-resolution peripheral computed tomography is a research tool lacking wide availability. In contrast, the trabecular bone score is a novel and widely available tool that uses gray-scale variograms of the spine image from dual-energy x-ray absorptiometry to assess trabecular quality. There are no studies assessing whether trabecular bone score characterizes bone quality in kidney transplant recipients.

DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS:

Between 2009 and 2010, we conducted a study to assess changes in peripheral skeletal microarchitecture, measured by high-resolution peripheral computed tomography, during the first year after transplantation in 47 patients managed with early corticosteroid-withdrawal immunosuppression. All adult first-time transplant candidates were eligible. Patients underwent imaging with high-resolution peripheral computed tomography and dual-energy x-ray absorptiometry pretransplantation and 3, 6, and 12 months post-transplantation. We now test if, during the first year after transplantation, trabecular bone score assesses the evolution of bone microarchitecture and biomechanical competence as determined by high-resolution peripheral computed tomography.

RESULTS:

At baseline and follow-up, among the 72% and 78%, respectively, of patients having normal bone mineral density by dual-energy x-ray absorptiometry, 53% and 50%, respectively, were classified by trabecular bone score as having high fracture risk. At baseline, trabecular bone score correlated with spine, hip, and ultradistal radius bone mineral density by dual-energy x-ray absorptiometry and cortical area, density, thickness, and porosity; trabecular density, thickness, separation, and heterogeneity; and stiffness and failure load by high-resolution peripheral computed tomography. Longitudinally, each percentage increase in trabecular bone score was associated with increases in trabecular number (0.35%±1.4%); decreases in trabecular thickness (-0.45%±0.15%), separation (-0.40%±0.15%), and network heterogeneity (-0.48%±0.20%); and increases in failure load (0.22%±0.09%) by high-resolution peripheral computed tomography (all P<0.05).

CONCLUSIONS:

Trabecular bone score may be a useful method to assess and monitor bone quality and strength and classify fracture risk in kidney transplant recipients.

KEYWORDS:

Absorptiometry, Photon; Adrenal Cortex Hormones; Adult; Bone Density; Bone and Bones; Follow-Up Studies; Fractures, Bone; Humans; Porosity; Radius; Spine; Tomography; kidney transplantation; mineral metabolism; renal osteodystrophy; renal transplantation

PMID:
28348031
PMCID:
PMC5383391
DOI:
10.2215/CJN.09850916
[Indexed for MEDLINE]
Free PMC Article

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