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

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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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania

    Roxana Dusceac, Dan Alexandru Niculescu, Ramona Dobre, Madalina Cristina Dragne & Catalina Poiana

  2. Diaverum Dialysis Center, 2N Industiilor blvd, 032895, Bucharest, Romania

    Catalin Tacu

  3. Department of Nephrology, Carol Davila University of Medicine and Pharmacy, 13 Vitan-Barzesti rd, 042122, Bucharest, Romania

    Ileana Peride, Cristiana David & Ionel Checherita

Authors
  1. Roxana Dusceac
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  2. Dan Alexandru Niculescu
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  4. Madalina Cristina Dragne
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  5. Catalin Tacu
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  7. Cristiana David
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  9. Catalina Poiana
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Corresponding author

Correspondence to Dan Alexandru Niculescu.

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

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Dusceac, R., Niculescu, D.A., Dobre, R. et al. Chronic hemodialysis is associated with lower trabecular bone score, independent of bone mineral density: a case-control study. Arch Osteoporos 13, 125 (2018). https://doi.org/10.1007/s11657-018-0541-6

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  • DOI: https://doi.org/10.1007/s11657-018-0541-6

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