Biopsy vs. peripheral computed tomography to assess bone disease in CKD patients on dialysis: differences and similarities

Marques, Inara; Araujo, Maria Júlia Correia Lima Nepomuceno; Graciolli, Fabiana G.; Reis, Luciene M. dos; Pereira, Rosa Maria Rodrigues; Custódio, Melani Ribeiro; Jorgetti, Vanda; Elias, Rosilene Motta; David‐Neto, Elias; Moysés, Rosa Maria Affonso

doi:10.1007/s00198-017-3956-9

Cited by 37 publications

(30 citation statements)

References 28 publications

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“…Combined, these parameters could identify the turnover status better than the parameters could individually. 23 However, this was not confirmed in this prospective analysis (data not shown). This study has some limitations.…”

Section: Discussionmentioning

confidence: 57%

A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation

Marques¹,

Araujo

Graciolli

et al. 2019

JASN

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Background Bone and mineral disorders commonly affect kidney transplant (KTx) recipients and have been associated with a high risk of fracture. Bisphosphonates may prevent or treat bone loss in such patients, but there is concern that these drugs might induce adynamic bone disease (ABD). MethodsIn an open label, randomized trial to assess the safety and efficacy of zoledronate for preventing bone loss in the first year after kidney transplant, we randomized 34 patients before transplant to receive zoledronate or no treatment. We used dual-energy x-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and bone biopsies to evaluate changes in bone in the 32 evaluable participants between the time of KTx and 12 months post-transplant.Results Both groups of patients experienced decreased bone turnover after KTx, but zoledronate itself did not affect this outcome. Unlike previous studies, DXA showed no post-transplant bone loss in either group; we instead observed an increase of bone mineral density in both lumbar spine and total hip sites, with a significant positive effect of zoledronate. However, bone biopsies showed post-transplant impairment of trabecular connectivity (and no benefit from zoledronate); HR-pQCT detected trabecular bone loss at the peripheral skeleton, which zoledronate partially attenuated.Conclusions Current immunosuppressive regimens do not contribute to post-transplant central skeleton trabecular bone loss, and zoledronate does not induce ABD. Because fractures in transplant recipients are most commonly peripheral fractures, clinicians should consider bisphosphonate use in patients at high fracture risk who have evidence of significantly low bone mass at these sites at the time of KTx.

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Section: Discussionmentioning

confidence: 57%

A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation

Marques¹,

Araujo

Graciolli

et al. 2019

JASN

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“…Noteworthy, we have previously validated the use of QCT for trabecular bone in predialysis CKD patients [10]. Moreover, other authors using HR-pQCT could demonstrate an inverse correlation between cortical density and cortical bone porosity, in hemodialysis patients [36].…”

Section: Discussionmentioning

confidence: 73%

Cortical unlike trabecular bone loss is not associated with vascular calcification progression in CKD patients

et al. 2020

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Background: Vascular calcification progression has been associated with the loss of trabecular bone in chronic kidney disease (CKD) patients. There are few data evaluating the relationship between cortical bone loss and vascular calcification in this population. The aim of this study was to prospectively evaluate the association between changes in cortical bone density and coronary artery calcification (CAC) progression in non-dialyzed CKD patients. Methods:Changes of cortical and trabecular bone, and changes of calcium score, were analyzed using vertebral tomographic images from a prospective study. Automatic delineation of the cortical bone layer was performed by Image J software, and trabecular bone was determined by selecting a region of interest using Vitrea 2® software. Cortical and trabecular bone density (BD) were expressed in Hounsfield Units (HU), and coronary artery calcium score in Agatston Units (AU).Results: Seventy asymptomatic patients [57.8 ± 10.2 years, 63% males, 20% diabetic, estimated glomerular filtration rate (eGFR) = 37.3 (24.8-51.3) mL/min/1.73m 2 ] were followed for 24 months. The mean cortical and trabecular BD did not change over time. While 49 patients lost either bone, 29 (41%) patients lost cortical [− 4.4%/year (ranging from − 7.15 to − 0.5)] and 39 (56%) lost trabecular bone [− 3.15%/year (− 13.7 to − 0.25)]. There was no association between cortical and trabecular BD changes (p = 0.12). CAC was observed in 33 (46%) patients at baseline, and 30 (91%) of them showed CAC progression. While an inverse correlation between trabecular bone and calcium score changes was observed (p = 0.001), there was no correlation between cortical bone and calcium score changes (p = 0.34). Conclusion: CKD patients experience either cortical or trabecular bone loss over time, but these changes do not take place simultaneously in all patients. Cortical, unlike trabecular bone loss, is not associated with vascular calcification progression in these patients.

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“…Singlecenter data and the limited number of follow-up bone biopsy samples restrict the statistical power of this study and extrapolation of results to all kidney transplant recipients. Another limitation is the lack of analysis of cortical bone, which might have offered additional information about bone metabolism (29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

Changes in Bone Histomorphometry after Kidney Transplantation

Keronen

Martola

Finne

et al. 2019

CJASN

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Background: Over the past decade, the management of chronic kidney disease-mineral and bone disorder has changed substantially, altering the pattern of bone disease in chronic kidney disease. We aimed to evaluate the natural history of kidney bone disease in contemporary kidney transplant recipients and dialysis patients. Design, settings, participants, and measurement: Sixty-one dialysis patients referred to kidney transplantation participated in this prospective cohort study during November 2009 and December 2010. We performed baseline bone biopsies while the patients were on dialysis and repeated the procedure in 56 patients two years after kidney transplantation or two years after baseline if transplantation was not performed. Measurements of mineral metabolism and bone turnover as well as dual energy X-ray absorptiometry scans were obtained concurrently. Results: 37 of 56 participants received a kidney transplant, of which 27 underwent successful repeat bone biopsy. The proportion of patients with high bone turnover declined from 63% at baseline to 19% two years after kidney transplantation, while the proportion of those with low bone turnover increased from 26% to 52%. Of 19 participants remaining on dialysis after two years, 13 underwent successful repeat biopsy. The proportion of patients remaining on dialysis with high bone turnover decreased from 69% to 31%, and low bone turnover increased from 8% to 38%. Abnormal bone mineralization increased in transplant recipients from 33% to 44%, but decreased in patients remaining on dialysis from 46% to 15%. Trabecular bone volume showed little change after transplantation, but low bone volume increased in patients remaining on dialysis. Bone mineral density did not correlate with histomorphometric findings. Conclusions: Bone turnover decreased over time both in patients remaining on dialysis and in kidney transplant recipients. Bone mineral density and bone biomarkers were not associated with bone metabolism changes detected in bone biopsy.

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Biopsy vs. peripheral computed tomography to assess bone disease in CKD patients on dialysis: differences and similarities

Cited by 37 publications

References 28 publications

A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation

A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation

Cortical unlike trabecular bone loss is not associated with vascular calcification progression in CKD patients

Changes in Bone Histomorphometry after Kidney Transplantation

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