Femoral bone mineral density reflects histologically determined cortical bone volume in hemodialysis patients

Abstract

Summary We evaluated the associations between dual energy X-ray absorptiometry (DXA) and histologically determined cancellous and cortical bone volume by controlling for vascular calcifications and demographic variables in hemodialysis (HD) patients. Femoral bone mineral density (f-BMD) was associated with cortical porosity. Introduction Assessment of bone mass in chronic kidney disease patients is of clinical importance because of the association between low bone volume, fractures, and vascular calcifications. DXA is used for noninvasive assessment of bone mass whereby vertebral results reflect mainly cancellous bone and femoral results reflect mainly cortical bone. Bone histology allows direct measurements of cancellous and cortical bone volume. The present study evaluates the association between DXA and histologically determined cancellous and cortical bone volumes in HD patients. Methods In 38 HD patients, DXA was performed for assessment of bone mass, anterior iliac crest bone biopsies for bone volume, and multislice computed tomography for vascular calcifications. Results While lumbar bone mineral density (l-BMD) by DXA was not associated with histologically measured cancellous bone volume, coronary Agatson score showed a borderline statistically significant association (P=0.055). When controlled for age and dialysis duration, f-BMD by DXA was associated with cortical porosity determined by histology (P=0.005). Conclusions The usefulness of l-BMD for predicting bone volume is limited most probably because of interference by soft tissue calcifications. In contrast, f-BMD shows significant association with cortical porosity.

Deterioration of Cortical Bone Microarchitecture: Critical Component of Renal Osteodystrophy Evaluation

“…This study supports recent histomorphometric [25, 26, 37, 38] and imaging studies [16, 17, 27, 39, 40] that have reported changes in cortical bone microarchitecture in individuals with CKD. In a cross-sectional study involving 38 dialysis patients, Adragao et al [25] reported high cortical porosity in 57% and reported a significant inverse relationship between femoral bone mineral density and cortical porosity.…”

“…However, relatively few studies have endeavoured to use histomorphometry [25, 26] or micro-CT of bone trephine samples, or utilised non-invasive techniques [16, 17, 27] to assess cortical microarchitecture and porosity in patients with CKD G5, 5D or after kidney transplantation. In the current study, 50% of patients had changes consistent with high bone turnover on histomorphometry, accompanied by elevated PTH values, but all participants had markedly abnormal cortical microarchitecture assessed by micro-CT with relatively preserved trabecular structural parameters.…”

“…In a cross-sectional study involving 38 dialysis patients, Adragao et al [25] reported high cortical porosity in 57% and reported a significant inverse relationship between femoral bone mineral density and cortical porosity. The presence of high cortical porosity and reduced cortical thickness in dialysis patients was also reported by Malluche et al [26] in a large histomorphometry study of 630 bone biopsies.…”

Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional, longitudinal study

“…Previous studies have reported decreased BMD in patients on dialysis (11–13), but although BMD measurements have been found useful for screening or assessing fractures (6) only few larger longitudinal studies are available on dialysis patients (14,15). The pattern of bone loss may be changing with the quality and duration of dialysis treatment and the age of the dialysis population.…”

Comment je traite les troubles phosphocalciques en cas d’insuffisance rénale chronique

“…La DMO ne peut donc pas apporter d'élément d'orientation diagnostique en faveur d'une HPT, d'une OA ou d'une OM dont les traitements restent très différents [37]. Enfin, la DMO vertébrale est souvent faussée par les calcifications aortiques ou intervertébrales et il faut certainement privilégier le site du col du fémur et du poignet [38]. Pour toutes ces raisons, la DMO n'est pas prescrite systématiquement, mais uniquement en cas de pathologie fracturaire.…”