scholarly journals P0896TRABECULAR BONE SCORE PREDICTS OSTEOPOROTIC FRACTURE IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Eunjin Bae ◽  
Tae Won Lee ◽  
Ha Nee Jang ◽  
Hyun Seop Cho ◽  
Hyun-Jung Kim ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Lumbar Spine ◽  
Kidney Disease ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Osteoporotic Fracture ◽  
Risk Group ◽  
Total Hip ◽  
T Score ◽  
Femur Neck

Abstract Background and Aims Chronic kidney disease and mineral bone disease (CKD-MBD) is a common complication of CKD and this is associated with higher risk of fracture, morbidity and mortality. Current guidelines recommend measurement of bone mineral density (BMD) in CKD patients. However, the focus is only on bone turnover and bone density, and there is no guideline for trabecular bone score (TBS) for trabecular bone microarchitecture in CKD patients. We aim to evaluate the role of TBS in predicting osteoporotic fracture in CKD patients Method We retrospectively enrolled 125 patients with CKD between 2016 and March 2019. Lumbar spine TBS was extracted from dual-energy X-ray absorptiometry, and we categorized the TBS into three groups as lowest (≥ 1.31), moderate (1.31-1.23), and highest risk group (≤ 1.23). The logistic regression analysis was used to assess osteoporotic fracture risk. Results Of 125 patients, mean age was 65.9 ± 14.2 years, 49.6% were on dialysis, 11.2% was highest risk group by TBS. Patients with highest risk group by TBS were significantly older, had lower height, weight, serum 25-OH vitamin D, serum sodium level, BMD T-score (lumbar spine, femur neck and total hip) than lower risk group. TBS significantly correlated with BMD T-score (lumbar spine, femur neck and total hip), height, weight and serum creatinine level (P <0.001). Osteoporotic fracture was identified in 20 (16.0%) patients. In univariate analyses, old age, women, lower weight, TBS tertile group, lower potassium level were significantly associated with osteoporotic fracture. In multivariate analyses, only highest risk group by TBS was significantly associated with increased osteoporotic fracture risk after adjustment for demographic, comorbid, medication use, and previous fracture. Conclusion Lumbar spine TBS significantly correlated with BMD T-score and predicts osteoporotic fractures in patients with CKD.

scholarly journals Osteoporosis in spine surgery patients: what is the best way to diagnose osteoporosis in this population?

2020 ◽  
Vol 49 (2) ◽  
pp. E4 ◽  
Author(s):  
Jeffery D. St. Jeor ◽  
Taylor J. Jackson ◽  
Ashley E. Xiong ◽  
Aamir Kadri ◽  
Brett A. Freedman ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Spine Surgery ◽  
Bone Health ◽  
Assessment Tools ◽  
Lumbar Spine Surgery ◽  
Total Hip ◽  
T Score ◽  
Preoperative Optimization ◽  
The Mean

OBJECTIVEThe goal of this study was to compare different recognized definitions of osteoporosis in patients with degenerative lumbar spine pathology undergoing elective spinal fusion surgery to determine which patient population should be considered for preoperative optimization.METHODSA retrospective review of patients in whom lumbar spine surgery was planned at 2 academic medical centers was performed, and the rate of osteoporosis was compared based on different recognized definitions. Assessments were made based on dual-energy x-ray absorptiometry (DXA), CT Hounsfield units (HU), trabecular bone score (TBS), and fracture risk assessment tool (FRAX). The rate of osteoporosis was compared based on different definitions: 1) the WHO definition (T-score ≤ −2.5) at total hip or spine; 2) CT HU of < 110; 3) National Bone Health Alliance (NBHA) guidelines; and 4) “expanded spine” criteria, which includes patients meeting NBHA criteria and/or HU < 110, and/or “degraded” TBS in the setting of an osteopenic T-score. Inclusion criteria were adult patients with a DXA scan of the total hip and/or spine performed within 1 year and a lumbar spine CT scan within 6 months of the physician visit.RESULTSTwo hundred forty-four patients were included. The mean age was 68.3 years, with 70.5% female, 96.7% Caucasian, and the mean BMI was 28.8. Fracture history was reported in 53.8% of patients. The proportion of patients identified with osteoporosis on DXA, HUs, NBHA guidelines, and the authors’ proposed “expanded spine” criteria was 25.4%, 36.5%, 75%, and 81.9%, respectively. Of the patients not identified with osteoporosis on DXA, 31.3% had osteoporosis based on HU, 55.1% had osteoporosis with NBHA, and 70.4% had osteoporosis with expanded spine criteria (p < 0.05), with poor correlations among the different assessment tools.CONCLUSIONSLimitations in the use of DXA T-scores alone to diagnose osteoporosis in patients with lumbar spondylosis has prompted interest in additional methods of evaluating bone health in the spine, such as CT HU, TBS, and FRAX, to inform guidelines that aim to reduce fracture risk. However, no current osteoporosis assessment was developed with a focus on improving outcomes in spinal surgery. Therefore, the authors propose an expanded spine definition for osteoporosis to identify a more comprehensive cohort of patients with potential poor bone health who could be considered for preoperative optimization, although further study is needed to validate these results in terms of clinical outcomes.

scholarly journals RISK FACTORS FOR IMPAIRED BONE DENSITY IN MALE PATIENTS UNDERWENT HEMODIALYSIS DUE TO CHRONIC KIDNEY DISEASE

2019 ◽  
Vol 7 (2) ◽  
pp. 125
Author(s):  
Patritius Kelik Dwi Santo Ismoyo ◽  
Sugeng Yuwana
Keyword(s):  
Chronic Kidney Disease ◽  
Lumbar Spine ◽  
Bone Density ◽  
Kidney Disease ◽  
Femoral Neck ◽  
Mineral Metabolism ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Total Hip ◽  
Male Patients

Background: Chronic kidney disease (CKD) is associated with impairment of mineral metabolism that, in turn, may result in the derangement of bone density, i.e. osteopenia or osteoporosis. Purpose: The objective of this study is to assess the impairment of bone density in male patients underwent routine hemodialysis due to stage V CKD.Methods: Subjects in this cross sectional study were male patients underwent routine hemodialysis in Hemodialysis Unit Dr. Sardjito General Hospital Yogyakarta in June 2014. Subjects were invited when they were over 18 years old and had undergone hemodialysis for at least 6 months. Bone density of lumbar spine, total hip and femoral neck were assessed using DEXA. We collected information on age and the etiology of the CKD from medical records. Body weight and height were measured using calibrated apparatus. Data were analyzed using OpenEpi.Results: We invited 30 male patients with mean (SD) age of 56.8 (13.8) years. Bone density of lumbar spine and femoral neck were significantly associated with the duration of hemodialysis, i.e. OR (95% CI) of 31.7 (3.8-856.0), p=0.0003 and 12.0 (1.9-111.0), p=0.005, respectively for those underwent hemodialysis of more than 12 months. Obesity was only protective for the bone density of the total hip, OR(95%CI) of 0.1 (0.004-0.9), p=0.03. There was no association between the etiology of the CKD and the decrease in bone density.Conclusion: This study observed significant association between the duration of hemodialysis and bone density.

scholarly journals POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 294.2-294
Author(s):  
D. Ciardo ◽  
P. Pisani ◽  
F. A. Lombardi ◽  
R. Franchini ◽  
F. Conversano ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
P Value ◽  
T Score ◽  
Caucasian Women

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.References:[1]Diez Perez A et al. Aging Clin Exp Res 2019; 31(10):1375-1389.[2]Pisani P et al. Measurement 2017; 101:243–249.Disclosure of Interests:None declared

Outcomes of Degenerative Lumbar Spine Surgery in Patients with Chronic Kidney Disease Undergoing Hemodialysis

2017 ◽  
Vol 24 (3) ◽  
pp. 154
Author(s):  
Hae-Dong Jang ◽  
Joonghyun Ahn ◽  
Jae Chul Lee ◽  
Sung-Woo Choi ◽  
Sijohn Hong ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Lumbar Spine ◽  
Kidney Disease ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Degenerative Lumbar Spine

Evaluation of fracture risk in chronic kidney disease

2017 ◽  
Vol 30 (5) ◽  
pp. 653-661 ◽  
Author(s):  
Pablo Antonio Ureña Torres ◽  
Martine Cohen-Solal
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fracture Risk

scholarly journals Effect of denosumab on trabecular bone score in de novo kidney transplant recipients

2019 ◽  
Vol 34 (10) ◽  
pp. 1773-1780 ◽  
Author(s):  
Marco Bonani ◽  
Diana Frey ◽  
Nicole Graf ◽  
Rudolf P Wüthrich
Keyword(s):  
Lumbar Spine ◽  
Trabecular Bone ◽  
Kidney Transplant ◽  
De Novo ◽  
Trabecular Bone Score ◽  
Distal Tibia ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Total Hip

Abstract Background Kidney transplant recipients (KTR) are at risk to lose bone mass. The trabecular bone score (TBS) represents a recently developed parameter of lumbar spine trabecular bone texture that correlates with the occurrence of fractures. Methods We analysed the 1-year changes in TBS in 44 de novo KTR that were randomized 1:1 to denosumab or no treatment. TBS was derived from dual energy X-ray absorptiometry and was correlated with 1-year areal bone mineral density (aBMD) changes at the lumbar spine and total hip. Correlations were also performed with parameters of peripheral bone microarchitecture and bone strength at the distal tibia and distal radius, as assessed by high-resolution peripheral quantitative computed tomography (HRpQCT) and micro-finite element analysis. Results The baseline TBS in KTR amounted to 1.312 ± 0.101, which is lower than the TBS of an age-matched normal control population (range 1.364–1.471). The TBS correlated positively with aBMD at the lumbar spine (Spearman’s ρ = 0.56; P < 0.001) and total hip (ρ = 0.33; P < 0.05). The baseline TBS also correlated with HRpQCT-derived total (ρ = 0.49; P < 0.05) and trabecular volumetric BMD (ρ = 0.57; P < 0.01) and trabecular separation (ρ = −0.46; P < 0.05) at the tibia. Denosumab treatment led to an increase in TBS, paralleling the BMD changes at the lumbar spine. Conclusions The TBS is a useful additional score of bone health, which may help to better define fracture risk. Treatment with denosumab led to improved trabecular bone texture in de novo KTR in addition to its beneficial effect on BMD.

scholarly journals Correlation of Radiomorphometric Indices of the Mandible and Biochemical Parameters in Patients with Secondary Hyperparathyroidism Due to Chronic Kidney Disease

2019 ◽  
Vol 13 (03) ◽  
pp. 303-309 ◽  
Author(s):  
Stenio Medeiros Queiroz ◽  
Ana Luiza Dias Leite De Andrade ◽  
Patrícia Teixeira De Oliveira ◽  
Paulo Raphael Leite Maia ◽  
Ângelo Giuseppe Roncalli Da Costa Oliveira ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Trabecular Bone ◽  
Biochemical Parameters ◽  
Alveolar Bone ◽  
Mental Foramen ◽  
Mineral And Bone Disorder ◽  
Male And Female ◽  
Significance Level ◽  
Female Patients

Abstract Objective The aim was to correlate radiomorphometric indices and biochemical analyses as an auxiliary method in bone evaluation in male and female patients with chronic kidney disease–mineral and bone disorder (CKD-MBD) and controls. Materials and Methods Nine radiomorphometric indices and four biochemical parameters were obtained: mental index (MI), height at the mental foramen, total mandibular height (THM), panoramic mandibular index (PMI), original height of the mandible, alveolar bone resorption, distance from the mental foramen to the alveolar bone crest (MF-ABC), mandibular cortical index (MCI), trabecular bone pattern, parathyroid hormone (PTH), calcium (Ca), phosphorus (P), and Ca × P product (Ca × P).Statistical Analysis The Mann–Whitney U-test, chi-squared test, and Spearman’s correlation were applied at a significance level of 95%. Results There was a moderate negative and significant correlation between MI, PMI, and PTH in female patients with CKD-MBD as well as between THM, MF-ABC, and Ca × P. The MCI and trabecular bone pattern indicated altered bone quality in male patients. Conclusions The radiomorphometric evaluation was an auxiliary, noninvasive method to detect possible alterations in the cortex and mandibular bone trabeculation in male and female patients with CKD-MBD.

Bone mineral density and biochemical markers of bone metabolism in predialysis patients with chronic kidney disease

2016 ◽  
Vol 64 (4) ◽  
pp. 861-866 ◽  
Author(s):  
Nuri Fidan ◽  
Ayca Inci ◽  
Melahat Coban ◽  
Cevval Ulman ◽  
Seyhun Kursat
Keyword(s):  
Bone Mineral Density ◽  
Chronic Kidney Disease ◽  
Alkaline Phosphatase ◽  
Kidney Disease ◽  
Bone Loss ◽  
Bone Mineral ◽  
Serum Alkaline Phosphatase ◽  
Mineral Density ◽  
T Score ◽  
Z Scores

The aim of the study was to evaluate the usefulness of serum bone turnover markers (BTM) and bone mineral density (BMD) determined by dual-energy X-ray absorptiometry (DEXA) in predialysis patients with chronic kidney disease (CKD). We enrolled 83 patients with CKD, 41 (49.4%) males, 42 (50.6%) females, with mean estimated glomerular filtration rate (eGFR) 23.90±12 (range=6.0–56.0). BMD of the lumbar spine (LS) (anteroposterior, L2 through L4), femoral neck (FN) and femoral trochanter (FT) were measured by DEXA. Biochemical BTM, including calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), serum specific alkaline phosphatase (serum AP), bone-specific AP (BSAP), plasma bicarbonate and 25-hydroxy-vitamin D (25hD) were used for the prediction of BMD loss. T score results of LS and FN were worse than FT. BMD levels were lower in females than in males (all p<0.05). According to different BMD T score levels, patients with age ≥65 years and patients in menopause were significantly more osteopenic (p=0.026) and there was no relation between different BMD T scores and presence of diabetes (p=0.654). A positive correlation was identified between the BMD of FN T-Z scores (r=0.270, p=0.029, r=0.306, p=0.012), FT T-Z scores (r=0.220, p=0.076, r:0.250, p=0.043) and serum HCO3, while the correlation with serum alkaline phosphatase (AP) and BSAP was considered to be negative. No statistically significant association was found between BMD of all the measured skeletal sites and eGFR. Loss of BMD was identified mostly in females over ≥65 years of age and after menopause. Higher serum levels of BSAP and AP can be determined in the advanced stages of renal failure and they reflect fracture risk of the femur, but not spine. Measurements of BMD by DEXA are useful to demonstrate bone loss, but not technical enough to distinguish the quantity of bone loss between different stages of CKD.

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