K Kim1, S H Song2, I-J Kim1,3, Y K Jeon4. 1. Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. 2. Division of Nephrology, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. 3. Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Gudeok-ro 179, Seo-gu, Busan, 602-739, South Korea. 4. Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Gudeok-ro 179, Seo-gu, Busan, 602-739, South Korea. puritystar@hanmail.net.
Abstract
Several patients with chronic kidney disease (CKD) have deteriorated bone status. Estimation of bone status using DXA has limitations especially in patients with CKD accompanying aortic calcifications. Quantitative CT and the trabecular bone score could be more accurate methods to estimate bone status for patients with CKD and vascular calcifications. INTRODUCTION: It remains unclear whether dual-energy absorptiometry (DXA) is appropriate for the assessment of bone status in patients with chronic kidney disease (CKD), a disease that impacts bone health. The aims of this study were to compare DXA and central quantitative computed tomography (cQCT) and to evaluate bone status in patients with pre-dialysis CKD. METHODS: This retrospective study included 363 healthy control subjects whose bone mineral density (BMD) was evaluated with DXA and 117 CKD patients whose BMD was evaluated using both cQCT and DXA. Diagnostic discordance was assessed between the lumbar spine (LS) and femur neck (FN) from DXA or between two modalities. The trabecular bone score (TBS) was extracted from DXA images. The volume of abdominal aortic calcification (AAC) was calculated using CT images from cQCT. RESULTS: Using LS DXA T-score, osteoporosis was less common in the CKD group than in controls. Patients with normal LS BMD using DXA were reclassified into osteopenia or osteoporosis using cQCT in CKD patients. Among discordant subjects between FN and LS in DXA, a higher BMD of LS was more common in CKD patients than in controls. CKD patients had lower TBS than controls despite having the same diagnosis using DXA. AAC volume negatively correlated with BMD from cQCT and with TBS but not with BMD from DXA. CONCLUSIONS: TBS and cQCT could accurately assess bone status in CKD patients since DXA may overestimate LS BMD, likely due to an increased AAC volume.
Several patients with chronic kidney disease (CKD) have deteriorated bone status. Estimation of bone status using DXA has limitations especially in patients with CKD accompanying aortic calcifications. Quantitative CT and the trabecular bone score could be more accurate methods to estimate bone status for patients with CKD and vascular calcifications. INTRODUCTION: It remains unclear whether dual-energy absorptiometry (DXA) is appropriate for the assessment of bone status in patients with chronic kidney disease (CKD), a disease that impacts bone health. The aims of this study were to compare DXA and central quantitative computed tomography (cQCT) and to evaluate bone status in patients with pre-dialysis CKD. METHODS: This retrospective study included 363 healthy control subjects whose bone mineral density (BMD) was evaluated with DXA and 117 CKD patients whose BMD was evaluated using both cQCT and DXA. Diagnostic discordance was assessed between the lumbar spine (LS) and femur neck (FN) from DXA or between two modalities. The trabecular bone score (TBS) was extracted from DXA images. The volume of abdominal aortic calcification (AAC) was calculated using CT images from cQCT. RESULTS: Using LS DXA T-score, osteoporosis was less common in the CKD group than in controls. Patients with normal LS BMD using DXA were reclassified into osteopenia or osteoporosis using cQCT in CKD patients. Among discordant subjects between FN and LS in DXA, a higher BMD of LS was more common in CKD patients than in controls. CKD patients had lower TBS than controls despite having the same diagnosis using DXA. AAC volume negatively correlated with BMD from cQCT and with TBS but not with BMD from DXA. CONCLUSIONS: TBS and cQCT could accurately assess bone status in CKD patients since DXA may overestimate LS BMD, likely due to an increased AAC volume.
Authors: S Moe; T Drüeke; J Cunningham; W Goodman; K Martin; K Olgaard; S Ott; S Sprague; N Lameire; G Eknoyan Journal: Kidney Int Date: 2006-06 Impact factor: 10.612
Authors: Kristine E Ensrud; Li-Ying Lui; Brent C Taylor; Areef Ishani; Michael G Shlipak; Katie L Stone; Jane A Cauley; Sophie A Jamal; Diana M Antoniucci; Steven R Cummings Journal: Arch Intern Med Date: 2007-01-22
Authors: A M Alem; D J Sherrard; D L Gillen; N S Weiss; S A Beresford; S R Heckbert; C Wong; C Stehman-Breen Journal: Kidney Int Date: 2000-07 Impact factor: 10.612
Authors: Olof Johnell; John A Kanis; Anders Oden; Helena Johansson; Chris De Laet; Pierre Delmas; John A Eisman; Seiko Fujiwara; Heikki Kroger; Dan Mellstrom; Pierre J Meunier; L Joseph Melton; Terry O'Neill; Huibert Pols; Jonathan Reeve; Alan Silman; Alan Tenenhouse Journal: J Bone Miner Res Date: 2005-03-07 Impact factor: 6.741
Authors: Markus Ketteler; Geoffrey A Block; Pieter Evenepoel; Masafumi Fukagawa; Charles A Herzog; Linda McCann; Sharon M Moe; Rukshana Shroff; Marcello A Tonelli; Nigel D Toussaint; Marc G Vervloet; Mary B Leonard Journal: Kidney Int Date: 2017-07 Impact factor: 10.612