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Nephrol Dial Transplant. 2019 Nov 7. pii: gfz195. doi: 10.1093/ndt/gfz195. [Epub ahead of print]

Patients with end-stage kidney disease have markedly abnormal cortical hip parameters by dual-energy X-ray absorptiometry.

Aleksova J1,2,3, Milat F1,2,3, Kotowicz MA4,5,6, Pasco JA4,5,6,7, Schultz C8, Wong P1,2,3, Ebeling PR2,3, Elder GJ9,10.

Author information

1
Hudson Institute for Medical Research, Clayton, Australia.
2
Department of Medicine, Monash University, Clayton, Australia.
3
Department of Endocrinology, Monash Health, Clayton, Australia.
4
Deakin University, Geelong, Australia.
5
Barwon Health, University Hospital, Geelong, Australia.
6
Department of Medicine-Western Health, University of Melbourne, St Albans, Australia.
7
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
8
Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital, Adelaide, Australia.
9
Department of Renal Medicine, Westmead Hospital, Sydney, Australia.
10
Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia.

Abstract

BACKGROUND:

Patients with end-stage kidney disease (ESKD) have higher fracture rates and post-fracture mortality than the general population, but bone mineral density by dual-energy X-ray absorptiometry (DXA) is less predictive of fracture in this patient group. Bone biopsy and high-resolution imaging indicate that cortical thickness (CT) is reduced and cortical porosity is increased in ESKD. The aim of this study was to assess cortical parameters using DXA in patients with ESKD. It was hypothesized that these parameters would show deterioration and be associated with fracture.

METHODS:

Using advanced hip analysis, normal age-related ranges were determined from 752 female and 861 male femur scans and were compared with scans of 226 patients with ESKD at the time of transplantation.

RESULTS:

Compared with controls, female patients had lower mean±SD CT (mms) at the femoral neck (FN) (2.59 ± 1.42 versus 5.23 ± 1.85), calcar (3.46 ± 1.07 versus 5.09 ± 1.30) and shaft (4.42 ± 1.21 versus 7.44 ± 2.07; P < 0.001 for each), and buckling ratios were higher (8.21 ± 4.6 versus 3.63 ± 1.42; P < 0.001), indicating greater FN instability. All findings were similar for men. Prevalent fracture was documented in 28.8% of patients; 12.4% vertebral only, 8.4% non-vertebral only and 8% vertebral plus non-vertebral. In adjusted models, each 1 SD reduction in FN CT and increase in the buckling ratio was associated with a respective 1.73 (1.22-2.46)- and 1.82 (1.49-2.86)-fold increase in the risk of prevalent vertebral fracture.

CONCLUSIONS:

In patients with ESKD, DXA-derived cortical parameters are markedly abnormal compared with age- and sex-matched controls. These parameters should be assessed for incident fracture prediction and targeting treatment.

KEYWORDS:

DXA; cortical bone; end-stage kidney disease; fracture

PMID:
31697355
DOI:
10.1093/ndt/gfz195

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