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. 2011 Sep;6(9):2264-71.
doi: 10.2215/CJN.09711010. Epub 2011 Jul 7.

Bone microarchitecture in hemodialysis patients assessed by HR-pQCT

Daniel Cejka  1 , Janina M Patsch, Michael Weber, Danielle Diarra, Markus Riegersperger, Zeljko Kikic, Christian Krestan, Claudia Schueller-Weidekamm, Franz Kainberger, Martin Haas
Affiliations

Bone microarchitecture in hemodialysis patients assessed by HR-pQCT

Daniel Cejka et al. Clin J Am Soc Nephrol. 2011 Sep.

Abstract

Background and objectives: Dialysis patients are at high risk for low-trauma bone fracture. Bone density measurements using dual-energy x-ray absorptiometry (DXA) do not reliably differentiate between patients with and without fractures. The aim of this study was to identify differences in bone microarchitecture between patients with and without a history of fracture using high-resolution peripheral quantitative computed tomography (HR-pQCT).

Design, setting, participants, & measurements: Seventy-four prevalent hemodialysis patients were recruited for measurements of areal bone mineral density (aBMD) by DXA and bone microarchitecture by HR-pQCT. Patients with a history of trauma-related fracture were excluded. Forty healthy volunteers served as controls. Blood levels of parathyroid hormone, vitamin D, and markers of bone turnover were determined.

Results: Dialysis patients, particularly women, had markedly impaired bone microarchitecture. Patients with fractures had significantly reduced cortical and trabecular microarchitecture compared with patients without fractures. aBMD tended to be lower in patients with fractures, but differences were statistically not significant. The strongest determinant of fracture was the HR-pQCT-measured trabecular density of the tibia, which also had the highest discriminatory power to differentiate patients according to fracture status. Radial DXA had a lower discriminatory power than trabecular density.

Conclusions: Bone microarchitecture is severely impaired in dialysis patients and even more so in patients with a history of fracture. HR-pQCT can identify dialysis patients with a history of low-trauma fracture.

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Figures

Figure 1.
Figure 1.
Two-dimensional reconstructions of high-resolution peripheral quantitative computed tomography measurements at the radius in two male dialysis patients (A) with and (B) without a history of low-impact fracture. Note the differences in cortical thickness and trabecular connectivity.
See this image and copyright information in PMC

References

    1. Barreto FC, Barreto DV, Moyses RMA, Neves KR, Canziani MEF, Draibe SA, Jorgetti V, Carvalho AB: K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients. Kidney Int 73: 771–777, 2008 - PubMed
    1. Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G: Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 69: 1945–1953, 2006 - PubMed
    1. Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C: Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58: 396–399, 2000 - PubMed
    1. Mares J, Ohlidalova K, Opatrna S, Ferda J: Determinants of prevalent vertebral fractures and progressive bone loss in long-term hemodialysis patients. J Bone Miner Metab 27: 217–223, 2009 - PubMed
    1. Jamal SA, Hayden JA, Beyene J: Low bone mineral density and fractures in long-term hemodialysis patients: A meta-analysis. Am J Kidney Dis 49: 674–681, 2007 - PubMed

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