Quantitative computed tomography for spinal bone mineral measurements in chronic renal failure

Abstract

The aim of this study was to assess non-invasively the status of spinal trabecular bone in patients with chronic renal failure and the influence of the disease stage. Single energy quantitative computed tomography (CT) was used in 89 patients with chronic renal failure to measure spinal trabecular bone equivalent density. 23 patients were independent of dialysis and 66 were receiving long-term haemodialysis. Spinal trabecular bone density of the patients was compared with locally determined normal ranges. Although trabecular bone mineral density (BMD) was lower (9% on average) in the patients who were not dependent on dialysis compared with the predicted mean normal values (BMDp) for age- and sex-matched normal subjects, the difference was not statistically significant. A statistically significant reduction was found in patients on dialysis (BMD/BMDp 0.75 +/- 0.16, Z-score -1.3). Osteosclerosis was found in 11 patients and they were excluded from the study. Longitudinal measurements in 42 patients on dialysis without osteosclerosis showed a 2.9% mean reduction in BMD/BMDp over a period of 8 months. All but one of the 16 haemodialysis patients with osteopenic spinal fractures had trabecular BMD values lower than the fracture threshold determined by our technique. In conclusion, end-stage chronic renal failure was associated with reduction in the spinal trabecular bone density.

Volumetric Bone Density and Geometry Assessed by Peripheral Quantitative Computed Tomography in Uremic Patients on Maintenance Hemodialysis

“…Karantanas et al [19] using single-energy CT found reduced values after exclusion of patients with osteosclerotic vertebrae, while Funke et al [20] employed dual-energy CT and found higher-than-normal values in 40%, normal values in 40% and lower-than-normal values in only 20% of unselected patients.…”

Imaging in the dialysis patient: Dialysis Bone Disease

“…Bone mineral density, particularly of cortical bone, may be reduced in ESRD and its treatments (dialysis and transplantation) (20–27). Secondary hyperparathyroidism is an important factor in this osteopenia (26), and BMD increases after parathyroidectomy (27) and tends to be less reduced in patients on CAPD as compared with those on hemodialysis (22).…”

Severe Cortical and Trabecular Osteopenia in Secondary Hyperparathyroidism

“…This hypothesis is further supported by the evidence of a significant decrease of the non-invasive index of bone strength (SSI), closely related to the architectural and mineral characteristics of the cortex. Karantanas et al also found low trabecular BMD values in a subset of 16 hemodialysis patients with osteopenic spinal fractures studied by quantitative computed tomography [26], although PTH levels were not specified. Although measurement of bone mineral density is not diagnostic of the type of metabolic bone disease affecting a specific dialysis patient, it may be useful to quantitate the severity of the disease process.…”

“…We showed that very high PTH levels might be detrimental to trabecular bone as well. Karantanas et al also found low trabecular BMD values in a subset of 16 hemodialysis patients with osteopenic spinal fractures studied by quantitative computed tomography [26], although PTH levels were not specified. In 18 women with primary hyperparathyroidism, Hesp et al also detected a mean deficit of 40% in trabecular bone density at the distal radius by pQCT [27].…”