A multi-imaging modality study of bone density, bone structure and the muscle - bone unit in end-stage renal disease

Leonard, Mary B.; Wehrli, Félix W.; Ziolkowski, Susan L.; Billig, Erica; Long, Jin; Nickolas, Thomas L.; Magland, Jeremy F.; Nihtianova, Snejana; Zemel, Babette S.; Herskovitz, Rita; Rajapakse, Chamith S.

doi:10.1016/j.bone.2019.05.022

Cited by 11 publications

(4 citation statements)

References 71 publications

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“…In spite of the bone biopsy remaining the gold standard for the determination of bone mineralization and turnover, these data show that this is not the best method to measure trabecular bone network. However, a disruption of trabecular network has been reported in CKD compared to controls using MRI, trabecular bone score, or texture analysis by BMA [16-18]. The value of these new techniques in discriminating patients at risk of fractures remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

Cortical Bone Microarchitecture in Dialysis Patients

et al. 2020

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Background: The incidence of skeletal fractures is high in dialysis patients. Current available tools are insufficient to predict bone fragility. We analyzed the microarchitecture in patients on dialysis therapy using bone biopsies and peripheral microcomputed tomography. Methods: We analyzed 12 trans-iliac bone biopsies of patients with recent fractures. Bone microarchitecture was assessed in the bone cores by histology (2D-), microcomputed tomography (3D-µCT), and high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia. Results: Trabecular bone volume/tissue volume was similar in 2D histology and 3D-µCT (p = 0.40), while lower in HR-pQCT (p < 0.01). There was no correlation in trabecular microarchitectural indices between 2-histology and 3D-µCT, or HR-pQCT. The 3D-µCT cortical thickness (Ct.Th) were positively correlated with 2D (p < 0.05), but with HR-pQCT (p = 0.33). Ct.Th was lower in patients with ≥2 vertebral fractures than with one fracture. Conclusions: 3D-µCT is a reliable method for the measurement of cortical bone in bone biopsies. Prospective studies are awaited to address its value in discriminating fracture risk.

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Section: Discussionmentioning

confidence: 99%

Cortical Bone Microarchitecture in Dialysis Patients

et al. 2020

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“…Fractures are associated with increased morbidity and all-cause mortality [ 3 ]. Compared with the general population, low bone mineral density (BMD) is more frequent [ 4 ] and predicts future fractures in patients on dialysis treatment [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Vitamin K supplementation and bone mineral density in dialysis: results of the double-blind, randomized, placebo-controlled RenaKvit trial

Levy-Schousboe

Marckmann

Frimodt‐Møller

et al. 2022

Nephrology Dialysis Transplantation

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Background Vitamin K deficiency is highly prevalent in patients on dialysis and may contribute to their low bone mineral density (BMD) and increased risk of fracture. This study investigated the effect of menaquinone-7 (MK-7) supplementation on BMD in patients on chronic dialysis. Methods In a multicenter double-blind placebo-controlled intervention trial, 123 patients on chronic dialysis were randomised to a daily oral supplement of either MK-7 360 µg or placebo for 2 years. BMD of the distal radius (1/3, mid, ultra-distal, and total), femoral neck, lumbar spine (L1-L4), and whole body was assessed by Dual-energy X-ray Absorptiometry. Serum levels of vitamin K1 and MK-7, and plasma levels of total osteocalcin, dephosphorylated-uncarboxylated matrix Gla protein, and Protein Induced by Vitamin K Absence-II were measured to assess vitamin K status. Results After 2 years, an accelerated BMD loss of the 1/3 distal radius was found with MK-7 supplementation (mean difference of changes relative to placebo -0.023 (95% CI (-0.039;-0.008)) g/cm2), whereas the decrease in lumbar spine BMD seen in the placebo group was prevented (mean difference of changes between groups 0.050 (95% CI (0.015;0.085)) g/cm2. No significant effects were observed at the remaining skeletal sites. Vitamin K status strongly improved in MK-7 supplemented participants. Conclusion Compared with placebo, an accelerated BMD loss of the 1/3 distal radius was found after 2 years of MK-7 supplementation, whereas a decline in lumbar spine BMD was prevented. As such, MK-7 supplementation might modify BMD site-specifically in patients on dialysis. In aggregate, our findings do not support MK-7 supplementation to preserve bone in patients on dialysis.

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“…MRI is a non-invasive technique that provides three-dimensional (3D) assessment of bone and can be used for monitoring changes, with the benefit of lack of exposure to ionising radiation in contrast to HR-pQCT. MRI has been used to evaluate bone in patients with kidney failure and peri- and post-kidney transplantation ( Wehrli et al, 2004 ; Sharma et al, 2018a ; Rajapakse et al, 2012 ; Link et al, 2002 ; Leonard et al, 2019 ; Rajapakse et al, 2017 ). We have previously reported abnormalities in bone microarchitecture, determined by MRI, in a cohort of patients undergoing parathyroidectomy for severe SHPT ( Ruderman et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism

Ruderman

Rajapakse

et al. 2021

Bone Reports

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Background Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA). Methods We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Results Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03). Conclusion Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness.

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A multi-imaging modality study of bone density, bone structure and the muscle - bone unit in end-stage renal disease

Cited by 11 publications

References 71 publications

Cortical Bone Microarchitecture in Dialysis Patients

Cortical Bone Microarchitecture in Dialysis Patients

Vitamin K supplementation and bone mineral density in dialysis: results of the double-blind, randomized, placebo-controlled RenaKvit trial

Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism

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