Evaluation of bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) in hemodialysis patients

Negri, Armando; Valle, Elisa Elena del; Zanchetta, María Belén; Nobaru, M.; Silveira, Fernando; Puddu, Marcelo; Barone, Roberto; Bogado, CE; Zanchetta, J. R.

doi:10.1007/s00198-011-1890-9

Cited by 45 publications

(37 citation statements)

References 34 publications

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“…By integrating all microstructural variables, FEA-determined bone strength might be a more valid outcome to study the consequences of ESRD on bone than isolated variables. These results are similar to two recent publications [14,15] and do not support the hypothesis of a selective cortical bone deficit in dialysis patients.…”

Section: Discussionsupporting

confidence: 85%

“…This variable was more predictive than any HR-pQCT parameter, and the addition of HR-pQCT results to ultradistal radius aBMD did not improve fracture discrimination [11]. In dialysis patients, Negri et al [14] found a marked decrease in cortical density, thickness, and area, together with reductions in trabecular parameters in both men and women. However, these changes correlated with the severity of secondary hyperparathyroidism in women only.…”

Section: Discussionmentioning

confidence: 95%

“…CT datasets from individual scans can be used for microstructural finite-element analysis (FEA) to assess bone mechanical competence (failure load and stiffness). Few studies have evaluated hemodialysis patients with these techniques [14,15], but they indicate an alteration of both cortical and trabecular bone compartments in relation to the severity of secondary hyperparathyroidism. The aim of this study was to analyze bone 3D microstructure, CtPo, and biomechanical properties in both compression (FEA) and torsion (polar moment of inertia) by HR-pQCT in ESRD patients compared to age-, gender-, and weightmatched healthy controls.…”

Section: Introductionmentioning

confidence: 99%

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Alterations of bone microstructure and strength in end-stage renal failure

et al. 2012

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Summary End-stage renal disease (ESRD) patients have a high risk of fractures. We evaluated bone microstructure and finite-element analysis-estimated strength and stiffness in patients with ESRD by high-resolution peripheral computed tomography. We observed an alteration of cortical and trabecular bone microstructure and of bone strength and stiffness in ESRD patients. Introduction Fragility fractures are common in ESRD patients on dialysis. Alterations of bone microstructure contribute to skeletal fragility, independently of areal bone mineral density. Methods We compared microstructure and finite-element analysis estimates of strength and stiffness by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 33 ESRD patients on dialysis (17 females and 16 males; mean age, 47.0±12.6 years) and 33 age-matched healthy controls. Results Dialyzed women had lower radius and tibia cortical density with higher radius cortical porosity and lower tibia cortical thickness, compared to controls. Radius trabecular number was lower with higher heterogeneity of the trabecular network. Male patients displayed only a lower radius cortical density. Radius and tibia cortical thickness correlated negatively with bone-specific alkaline phosphatase (BALP). Microstructure did not correlate with parathyroid hormone (PTH) levels. Cortical porosity correlated positively with "Kidney Disease: Improving Global Outcomes" working group PTH level categories (r00.36, p<0.04). BMI correlated positively with trabecular number (r00.4, p<0.02) and negatively with trabecular spacing (r0−0.37, p<0.03) and trabecular network heterogeneity (r0−0.4, p<0.02). Biomechanics positively correlated with BMI and negatively with BALP. Conclusion Cortical and trabecular bone microstructure and calculated bone strength are altered in ESRD patients, predominantly in women. Bone microstructure and biomechanical assessment by HR-pQCT may be of major clinical relevance in the evaluation of bone fragility in ESRD patients.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Alterations of bone microstructure and strength in end-stage renal failure

et al. 2012

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“…All aspects of bone microstructure were altered in HIV+ve successfully treated premenopausal women. The evaluation of bone microstructure changes using the same technique in hemodialysis patients has shown relative changes to a similar extent in both radius and tibia sites (29 % reduction in total and trabecular density with a trabecular number reduced by 25 %) [30]. Our findings raise certain questions.…”

Section: Discussionmentioning

confidence: 51%

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

et al. 2012

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Summary We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Introduction Bone fragility is an emerging issue in HIVinfected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. Methods We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age-and body mass index (BMI)-matched HIV-negative (−ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. Results In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5±3.5 (mean ± SD)years; median BMI was 22 (IQR, 21-26)kg/m 2 . More HIV+ve women were smokers (82 versus 50 %, p00.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score −0.70 vs −0.03, p00.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV−ve women (p00.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (−3.0 %; p00.029). Conclusions Compared with HIV−ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.

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“…Biochemical (calcium, phosphate, parathyroid hormone [PTH] and vitamin D) and bone abnormalities (renal osteodystrophy) complicating advanced CKD and dialysis are associated with significant morbidity and mortality (1)(2)(3)(4)(5)(6), probably due to greater risk of fracture and extra-skeletal calcification leading to cardiovascular disease (7)(8)(9). Severe SHPT in dialysis patients is associated with up to 20% increased mortality (4,5) and dialysis patients also have up to four fold increase in fracture incidence compared to non-dialysis patients (10) due to impaired bone quality (11,12). Vascular calcification is highly prevalent in CKD and is only weakly related to traditional risk factors of cardiovascular disease in the general population such as hypertension and hyperlipidaemia (13).…”

Section: Introductionmentioning

confidence: 99%

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

Salam

Khwaja

Wilkie

2016

Drugs

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or Article Brief (if supplied by editors): As a 'Therapy in Practice' article, we would like this to provide a succinct, up-to-date clinically orientated guide to the optimum management of secondary hyperparathyroidism in patients with chronic kidney disease. The review should include an appropriate background to the development of SHPT. It should focus primarily on pharmacological treatments but as appropriate, non-pharmacological approaches (dietary, surgical) may be discussed to fully place pharmacological therapy in context. Submission date: 31 st March 2016Word count: 4156 Compliance with Ethical StandardsFunding and conflict of interest statement from each author: Takeaway messages from the article SHPT is associated with adverse outcomes in CKD and dialysis patients  Optimum PTH level is unclear in pre-dialysis CKD and the recommended range is wide for dialysis patients.  Management of SHPT is largely pharmacological focussing on lowering PTH  PTH lowering treatment has not shown improved cardiovascular risk, fractures and mortality. AbstractSecondary hyperparathyroidism (SHPT) is a common complication of CKD and is part of the chronic kidney disease-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of fracture and mortality, thus SHPT control is recommended as kidney function declines. Effective SHPT management becomes more difficult once skeletal and cardiovascular adverse effects associated with severe SHPT have become established. However, interventional studies to lower parathyroid hormone (PTH) have so far shown inconsistent results in improving patient-centred outcomes such as mortality, cardiovascular events and fracture. Pharmacological treatment effect on PTH level is also inconsistent between predialysis CKD and dialysis patients which adds to the complexity of SHPT management. This review aims to give an overview on the pathophysiology, pharmacological and non-pharmacological treatment for SHPT in CKD including some of the limitations of current therapeutic options.

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Evaluation of bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) in hemodialysis patients

Abstract: We conclude that hemodialysis patients have a marked decreased in cortical density, thickness, and area with significant reduction in trabecular parameters that correlated with the severity of secondary hyperparathyroidism only in women.

Cited by 45 publications

References 34 publications

Alterations of bone microstructure and strength in end-stage renal failure

Alterations of bone microstructure and strength in end-stage renal failure

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

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