Kara L Holloway-Kew1, Pamela Rufus-Membere2, Kara B Anderson2, Amelia Betson2, James Gaston2, Mark A Kotowicz3, Adolfo Diez-Perez4, Natalie K Hyde2, Julie A Pasco5. 1. Deakin University, Geelong, Australia. Electronic address: k.holloway@deakin.edu.au. 2. Deakin University, Geelong, Australia. 3. Deakin University, Geelong, Australia; Barwon Health, Geelong, Australia; Melbourne Medical School - Western Campus, Department of Medicine, The University of Melbourne, St Albans, Australia. 4. Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona, CIBERFES, Instituto Carlos III, Spain. 5. Deakin University, Geelong, Australia; Barwon Health, Geelong, Australia; Melbourne Medical School - Western Campus, Department of Medicine, The University of Melbourne, St Albans, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Abstract
BACKGROUND: Patients with chronic kidney disease (CKD) are at high risk for fracture. The ability of bone mineral density (BMD) to predict fractures in CKD patients has been inconsistent. Other measures such as trabecular bone score (TBS) and impact microindentation (IMI) may be more useful in this group. This study aimed to determine if TBS or IMI values differed between men with and without CKD and examine associations between prior fracture, TBS and IMI values. METHODS: Men (n = 343, age 33-96 yr) from the Geelong Osteoporosis Study were included. Femoral neck (FNBMD) and lumbar spine BMD (LSBMD) were measured using DXA (Lunar ProdigyPro). TBS was determined from lumbar spine scans (TBS iNsight software Version 2.2). IMI values (bone material strength index; BMSi) were measured using an OsteoProbe. CKD was defined as an eGFR<60 mL/min/1.73m2 (n = 53). Prior low trauma fractures (n = 37) were ascertained from radiological reports. Associations were examined using binary logistic regression, adjusting for potential confounders. Interaction terms were tested in all models. RESULTS: Men with CKD tended to have a higher likelihood of prior fracture (adjusted OR 2.27, 95%CI 1.02-5.01). Higher BMSi was associated with a lower likelihood of prior fracture (adjusted OR for 1SD increase: 0.70; 95%CI 0.51-0.97). This association was sustained after adjustment for FNBMD (OR 0.68; 95%CI 0.49-0.96) or LSBMD (OR 0.69; 95%CI 0.49-0.95). No interaction was detected between BMSi and CKD (p = 0.898). No associations were detected between FNBMD, LSBMD or TBS and prior fracture in either population and there were no interactions with CKD for FNBMD, LSBMD or TBS. CONCLUSIONS: BMSi was associated with prior fracture in men with and without CKD, however, FNBMD, LSBMD and TBS were not. Lack of an interaction term suggests that BMSi performed similarly in identifying the likelihood of prior fracture, regardless of CKD status. IMI may have clinical utility for assessing fracture risk in patients with CKD.
BACKGROUND:Patients with chronic kidney disease (CKD) are at high risk for fracture. The ability of bone mineral density (BMD) to predict fractures in CKDpatients has been inconsistent. Other measures such as trabecular bone score (TBS) and impact microindentation (IMI) may be more useful in this group. This study aimed to determine if TBS or IMI values differed between men with and without CKD and examine associations between prior fracture, TBS and IMI values. METHODS:Men (n = 343, age 33-96 yr) from the Geelong Osteoporosis Study were included. Femoral neck (FNBMD) and lumbar spine BMD (LSBMD) were measured using DXA (Lunar ProdigyPro). TBS was determined from lumbar spine scans (TBS iNsight software Version 2.2). IMI values (bone material strength index; BMSi) were measured using an OsteoProbe. CKD was defined as an eGFR<60 mL/min/1.73m2 (n = 53). Prior low trauma fractures (n = 37) were ascertained from radiological reports. Associations were examined using binary logistic regression, adjusting for potential confounders. Interaction terms were tested in all models. RESULTS:Men with CKD tended to have a higher likelihood of prior fracture (adjusted OR 2.27, 95%CI 1.02-5.01). Higher BMSi was associated with a lower likelihood of prior fracture (adjusted OR for 1SD increase: 0.70; 95%CI 0.51-0.97). This association was sustained after adjustment for FNBMD (OR 0.68; 95%CI 0.49-0.96) or LSBMD (OR 0.69; 95%CI 0.49-0.95). No interaction was detected between BMSi and CKD (p = 0.898). No associations were detected between FNBMD, LSBMD or TBS and prior fracture in either population and there were no interactions with CKD for FNBMD, LSBMD or TBS. CONCLUSIONS: BMSi was associated with prior fracture in men with and without CKD, however, FNBMD, LSBMD and TBS were not. Lack of an interaction term suggests that BMSi performed similarly in identifying the likelihood of prior fracture, regardless of CKD status. IMI may have clinical utility for assessing fracture risk in patients with CKD.
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Authors: Maria Fusaro; Giulia Vanessa Re Sartò; Maurizio Gallieni; Laura Cosmai; Piergiorgio Messa; Maurizio Rossini; Iacopo Chiodini; Mario Plebani; Pieter Evenepoel; Nicholas Harvey; Serge Ferrari; Jorge Cannata-Andía; Andrea Trombetti; Maria Luisa Brandi; Markus Ketteler; Thomas L Nickolas; John Cunningham; Syazrah Salam; Carlo Della Rocca; Aldo Scarpa; Salvatore Minisola; Fabio Malberti; Filomena Cetani; Mario Cozzolino; Sandro Mazzaferro; Luigi Morrone; Giovanni Tripepi; Martina Zaninotto; Maria Cristina Mereu; Maura Ravera; Giuseppe Cianciolo; Gaetano La Manna; Andrea Aghi; Sandro Giannini; Luca Dalle Carbonare Journal: Nutrients Date: 2022-04-22 Impact factor: 6.706