Loss of bone mineral density and trabecular bone score in elderly hemodialysis patients: a 2-year follow-up, prospective, single-centre study

Brunerová, Ludmila; Kasalický, Petr; Verešová, Jana; Lažanská, Renata; Potočková, Jana; Rychlík, Ivan

doi:10.1007/s11255-020-02378-1

Cited by 2 publications

(4 citation statements)

References 31 publications

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“…Also, due to its simple, inexpensive, rapid, and noninvasive measurement, the handgrip strength evaluation may be considered in the clinical evaluation of CKD to identify patients suitable for further instrumental assessment of bone fragility. For the reason that DXA remains the gold-standard method to check for bone fragility, it appears valuable to also comprise the TBS calculation, at least in dialysis patients (36)(37)(38)(39)(40).…”

Section: Discussionmentioning

confidence: 99%

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Catalano¹,

Gaudio²,

Bellone³

et al. 2022

Front. Endocrinol.

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There is growing interest in the relationship between chronic kidney disease (CKD) and fragility fracture risk. Bone mineral density (BMD) is a major determinant of bone strength, although its role as a predictor of fracture in advanced CKD and hemodialysis is still under debate. We aimed to further investigate surrogates of bone quality and their associations with muscle strength and fracture risk in hemodialysis. Multiple clinical risk factors for fracture and an estimated 10-year probability of fracture, BMD at lumbar spine and femur, trabecular bone score (TBS), X-ray vertebral morphometry, phalangeal bone quantitative ultrasonography (QUS), tibial pulse-echo ultrasonography (PEUS), and handgrip strength were evaluated in a setting of hemodialysis patients in treatment with acetate-free biofiltration (AFB) or bicarbonate hemodialysis. The bone ultrasound measurements, both at phalangeal and tibial sites, were significantly associated with lumbar and femoral DXA values. Handgrip strength was significantly associated with the 10-year probability of fracture (r = −0.57, p < 0.001 for major fractures and r = −0.53, p < 0.001 for hip fracture, respectively), with femur neck, total femur, and L1–L4 BMD values (r = 0.47, p = 0.04; r = 0.48, p = 0.02; r = 0.58, p = 0.007, respectively), with TBS at the lumbar spine (r = 0.71, p < 0.001) and with the phalangeal QUS measure of AD-SoS (r = 0.369, p = 0.023). In the hemodialysis group, 10 participants (24.3%) reported at least one morphometric vertebral fracture (Vfx); conversely, only six participants (15%) showed Vfx in the control group. In the hemodialysis group, participants with Vfx compared with participants without Vfx reported significantly different TBS, bone transmission time (BTT), cortical thickness, and handgrip strength (p < 0.05). At multiple regression analysis, by identifying as dependent variable the 10-year fracture risk for major fracture, after correcting for age, BMI, time since dialysis, AD-SoS, cortical bone thickness, and handgrip strength, only BTT (β = −15.21, SE = 5.91, p = 0.02) and TBS (β = −54.69, SE = 21.88, p = 0.02) turned out as independently associated with fracture risk. In conclusion, hemodialysis patients showed a higher fracture risk and lower surrogate indices of bone strength as TBS and QUS parameters. In this cohort of patients, handgrip strength measurements appeared to be a useful instrument to identify high-fracture-risk subjects.

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Section: Discussionmentioning

confidence: 99%

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Catalano¹,

Gaudio²,

Bellone³

et al. 2022

Front. Endocrinol.

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“…The studies on TBS in maintenance dialysis (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) are listed in descending chronological order in Table 1.…”

Section: Findings Of the Available Studies Tbs In Maintenance Dialysis Vs Controlsmentioning

confidence: 99%

“…The majority of studies also reported data on fracture and fracture risk (16,(19)(20)(21)(23)(24)(25)(26). Most of the data come from cross-sectional studies that compared TBS between patients with and without prevalent fractures (21,(23)(24)(25)(26).…”

Section: Fracture Riskmentioning

confidence: 99%

“…Two prospective studies measured TBS at baseline and followed the patients for 20 ( 16 ) or 24 ( 19 ) months. The results were heterogeneous, with one study ( 16 ) showing lower TBS in those with incident fractures (1 vertebral, 1 hip, 2 lower extremities, and 3 upper extremities) while the other ( 19 ) found no significant differences (1 vertebral, 2 hip, 2 forearms, 1 humerus, and 1 rib).…”

Section: Findings Of the Available Studiesmentioning

confidence: 99%

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Utility of Trabecular Bone Score (TBS) in Bone Quality and Fracture Risk Assessment in Patients on Maintenance Dialysis

2022

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Maintenance dialysis is associated with almost universal changes in bone metabolism collectively known as chronic kidney disease—mineral and bone disorder (CKD-MBD). These are accompanied in various proportions by bone loss and altered bone quality that led to an increased risk of fracture. Osteoporosis, age-related or postmenopausal, a condition that often coexists with CKD, is also a leading cause of fracture. Dual-energy X-ray densitometry (DXA) is the main tool for assessing the bone quantity and bone loss and the associated fracture risk. It has been validated in both CKD-MBD and osteoporosis. Trabecular bone score (TBS) is a DXA-derived algorithm for the evaluation of bone microarchitecture, and its clinical value has been repeatedly demonstrated in large cohorts of osteoporotic patients. However, its utility in patients on maintenance dialysis has not been conclusively shown. Published studies showed a lower TBS score and implicitly an altered bone microarchitecture in patients on maintenance dialysis, even after adjusting for various variables. Moreover, FRAX-based fracture risk is higher after adjusting for TBS, showing promise on an algorithm better estimating the clinical fracture risk in dialysis patients. However, TBS has not been demonstrated to independently predict clinical fractures in prospective studies on dialysis patients. Also, aortic calcifications and altered fluid balance could significantly affect TBS score and could hamper the widespread clinical use in patients on maintenance dialysis. In this mini-review, we focus on the benefits and pitfalls of TBS in the management of CKD-MBD and fracture risk assessment in patients on maintenance dialysis.

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Loss of bone mineral density and trabecular bone score in elderly hemodialysis patients: a 2-year follow-up, prospective, single-centre study

Cited by 2 publications

References 31 publications

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Utility of Trabecular Bone Score (TBS) in Bone Quality and Fracture Risk Assessment in Patients on Maintenance Dialysis

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