K L Naylor1,2, L M Lix3, D Hans4, A X Garg1,5,6, D N Rush3, A B Hodsman6, W D Leslie7. 1. Institute for Clinical Evaluative Sciences (ICES), London, ON, Canada. 2. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. 3. Department of Medicine, University of Manitoba, Winnipeg, ON, Canada. 4. Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland. 5. Department of Epidemiology & Biostatistics, Western University, London, ON, Canada. 6. Division of Nephrology, Western University, London, ON, Canada. 7. Department of Medicine, University of Manitoba, Winnipeg, ON, Canada. BLESLIE@sbgh.mb.ca.
Abstract
SUMMARY: It is uncertain whether bone mineral density (BMD) can accurately predict fracture in kidney transplant recipients. Trabecular bone score (TBS) provides information independent of BMD. Kidney transplant recipients had abnormal bone texture as measured by lumbar spine TBS, and a lower TBS was associated with incident fractures in recipients. INTRODUCTION: Trabecular bone score (TBS) is a texture measure derived from dual energy X-ray absorptiometry (DXA) lumbar spine images, providing information independent of bone mineral density. We assessed characteristics associated with TBS and fracture outcomes in kidney transplant recipients. METHODS: We included 327 kidney transplant recipients from Manitoba, Canada, who received a post-transplant DXA (median 106 days post-transplant). We matched each kidney transplant recipient (mean age 45 years, 39% men) to three controls from the general population (matched on age, sex, and DXA date). Lumbar spine (L1-L4) DXA images were used to derive TBS. Non-traumatic incident fracture (excluding hand, foot, and craniofacial) (n = 31) was assessed during a mean follow-up of 6.6 years. We used multivariable linear regression models to test predictors of TBS, and multivariable Cox proportional hazard regression was used to estimate hazard ratios (HRs) per standard deviation decrease in TBS to express the gradient of risk. RESULTS: Compared to the general population, kidney transplant recipients had a significantly lower lumbar spine TBS (1.365 ± 0.129 versus 1.406 ± 0.125, P < 0.001). Multivariable linear regression revealed that receipt of a kidney transplant was associated with a significantly lower mean TBS compared to controls (-0.0369, 95% confidence interval [95% CI] -0.0537 to -0.0202). TBS was associated with fractures independent of the Fracture Risk Assessment score including BMD (adjusted HR per standard deviation decrease in TBS 1.64, 95% CI 1.15-2.36). CONCLUSION: Kidney transplant recipients had abnormal bone texture as assessed by TBS and a lower lumbar spine TBS was associated with fractures in recipients.
SUMMARY: It is uncertain whether bone mineral density (BMD) can accurately predict fracture in kidney transplant recipients. Trabecular bone score (TBS) provides information independent of BMD. Kidney transplant recipients had abnormal bone texture as measured by lumbar spine TBS, and a lower TBS was associated with incident fractures in recipients. INTRODUCTION: Trabecular bone score (TBS) is a texture measure derived from dual energy X-ray absorptiometry (DXA) lumbar spine images, providing information independent of bone mineral density. We assessed characteristics associated with TBS and fracture outcomes in kidney transplant recipients. METHODS: We included 327 kidney transplant recipients from Manitoba, Canada, who received a post-transplant DXA (median 106 days post-transplant). We matched each kidney transplant recipient (mean age 45 years, 39% men) to three controls from the general population (matched on age, sex, and DXA date). Lumbar spine (L1-L4) DXA images were used to derive TBS. Non-traumatic incident fracture (excluding hand, foot, and craniofacial) (n = 31) was assessed during a mean follow-up of 6.6 years. We used multivariable linear regression models to test predictors of TBS, and multivariable Cox proportional hazard regression was used to estimate hazard ratios (HRs) per standard deviation decrease in TBS to express the gradient of risk. RESULTS: Compared to the general population, kidney transplant recipients had a significantly lower lumbar spine TBS (1.365 ± 0.129 versus 1.406 ± 0.125, P < 0.001). Multivariable linear regression revealed that receipt of a kidney transplant was associated with a significantly lower mean TBS compared to controls (-0.0369, 95% confidence interval [95% CI] -0.0537 to -0.0202). TBS was associated with fractures independent of the Fracture Risk Assessment score including BMD (adjusted HR per standard deviation decrease in TBS 1.64, 95% CI 1.15-2.36). CONCLUSION: Kidney transplant recipients had abnormal bone texture as assessed by TBS and a lower lumbar spine TBS was associated with fractures in recipients.
Entities:
Keywords:
Bone mineral density; Fracture; Kidney transplant recipient; Trabecular bone score
Authors: S R Cummings; D M Black; M C Nevitt; W Browner; J Cauley; K Ensrud; H K Genant; L Palermo; J Scott; T M Vogt Journal: Lancet Date: 1993-01-09 Impact factor: 79.321
Authors: Eugene V McCloskey; Anders Odén; Nicholas C Harvey; William D Leslie; Didier Hans; Helena Johansson; John A Kanis Journal: Calcif Tissue Int Date: 2015-03-22 Impact factor: 4.333
Authors: Matthew Luckman; Didier Hans; Natalia Cortez; Kyle K Nishiyama; Sanchita Agarawal; Chengchen Zhang; Lucas Nikkel; Sapna Iyer; Maria Fusaro; Edward X Guo; Donald J McMahon; Elizabeth Shane; Thomas L Nickolas Journal: Clin J Am Soc Nephrol Date: 2017-03-27 Impact factor: 8.237
Authors: Kyla L Naylor; Jerilynn Prior; Amit X Garg; Claudie Berger; Lisa Langsetmo; Jonathan D Adachi; David Goltzman; Christopher S Kovacs; Robert G Josse; William D Leslie Journal: Clin J Am Soc Nephrol Date: 2016-10-24 Impact factor: 8.237