The trabecular bone score: Relationships with trabecular and cortical microarchitecture measured by HR-pQCT and histomorphometry in patients with chronic kidney disease

Ramalho, Janaina; Marques, Inara; Hans, Didier; Dempster, David W.; Zhou, Hua; Patel, Parth; Pereira, Rosa Maria Rodrigues; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Nickolas, Thomas L.

doi:10.1016/j.bone.2018.08.006

Cited by 50 publications

(40 citation statements)

References 41 publications

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“…TBS has also been investigated in patients with kidney disease. In a recent study of 50 patients with CKD 3‐5D, TBS was associated with trabecular bone volume, width, and spacing, as well as cortical width as measured by bone biopsy . Luckman and colleagues reported that TBS measures correlated with both cortical and trabecular microarchitecture by HR‐pQCT in ESKD patients before kidney transplantation and that changes in TBS measurements reflected changes in trabecular microarchitecture and failure load but not cortical microarchitecture 12 months after transplantation.…”

Section: Assessment Of Bone Microarchitecture—high‐resolution Imagingmentioning

confidence: 98%

Rethinking Bone Disease in Kidney Disease

Damasiewicz

Nickolas

2018

JBMR Plus

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Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD‐MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population. Furthermore, at a population level, fractures are at historically high levels in patients with end‐stage kidney disease (ESKD), whereas in contrast the general population has experienced a steady decline in fracture incidence rates. Based on these findings, it is clear that a paradigm shift is needed in our approach to diagnosing and managing ROD. In clinical practice, our ability to diagnose ROD and initiate antifracture treatments is impeded by the lack of accurate noninvasive methods that identify ROD type. The past decade has seen advances in the noninvasive measurement of bone quality and strength that have been studied in kidney disease patients. Below we review the current literature pertaining to the epidemiology, pathology, diagnosis, and management of ROD. We aim to highlight the pressing need for a greater awareness of this condition and the need for the implementation of strategies that prevent fractures in kidney disease patients. Research is needed for more accurate noninvasive assessment of ROD type, clinical studies of existing osteoporosis therapies in patients across the spectrum of kidney disease, and the development of CKD‐specific treatments. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Section: Assessment Of Bone Microarchitecture—high‐resolution Imagingmentioning

confidence: 98%

Rethinking Bone Disease in Kidney Disease

Damasiewicz

Nickolas

2018

JBMR Plus

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“…Moreover, TBS is inexpensive, non-invasive, and readily clinically available compared to non-DXA imaging or bone biopsy [ 10 , 11 ]. Previous studies have demonstrated that TBS correlates with both cortical and trabecular 3-dimensional microarchitecture parameters, such as trabecular volume, number, thickness, spacing, connectivity, and stiffness measured by HR-pQCT or micro-CT [ 12 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Trabecular bone score may indicate chronic kidney disease-mineral and bone disorder (CKD-MBD) phenotypes in hemodialysis patients: a prospective observational study

et al. 2020

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Background In the general population, the trabecular bone score (TBS) represents the bone microarchitecture and predicts fracture risk independent of bone mineral density (BMD). A few studies reported that TBS is significantly reduced in dialysis patients. Chronic kidney disease-mineral and bone disorder (CKD-MBD) are accompanied by increased fracture risk, cardiovascular morbidity, and mortality. We investigated whether TBS is associated with comorbidity related to CKD-MBD or frailty in hemodialysis patients. Methods In this prospective observational study, TBS was obtained using the TBS iNsight software program (Med-Imaps) with BMD dual energy x-ray absorptiometry (DXA) images (L1–L4) from prevalent hemodialysis patients. A Tilburg frailty indicator was used to evaluate frailty, and hand grip strength and bio-impedance (InBody) were measured. A patient-generated subjective global assessment (PG-SGA) was used for nutritional assessment. The history of cardiovascular events (CVE) and demographic, clinical, laboratory, and biomarker data were collated. We then followed up patients for the occurrence of CKD-MBD related complications. Results We enrolled 57 patients in total. The mean age was 56.8 ± 15.9 years (50.9% female). Prevalence of Diabetes mellitus (DM) was 40.4% and CVE was 36.8%. Mean TBS was 1.44 ± 0.10. TBS significantly reduced in the CVE group (1.38 ± 0.08 vs. 1.48 ± 0.10, p < 0.001). Multivariable regression analysis was conducted adjusting for age, sex, dialysis vintage, DM, CVE, albumin, intact parathyroid hormone, fibroblast growth factor 23, handgrip strength, and phosphate binder dose. Age ( ß = − 0.030; p = 0.001) and CVE ( ß = − 0.055; p = 0.024) were significant predictors of TBS. During the follow up period after TBS measurements (about 20 months), four deaths, seven incident fractures, and six new onset CVE were recorded. Lower TBS was associated with mortality ( p = 0.049) or new onset fracture ( p = 0.007, by log-rank test). Conclusion Lower TBS was independently associated with increased age and CVE prevalence in hemodialysis patients. Mortality and fracture incidence were significantly higher in patients with lower TBS values. These findings suggest that TBS may indicate a phenotype of frailty and also a CKD-MBD phenotype reciprocal to CVE.

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“…It is easily applied to a DXA image using a specific software (TBS iNsight ® —Medimaps) and has the advantage of the possibility of being retrospectively calculated from an existing DXA image without the need for further imaging. Trabecular bone score has been shown to be associated with volumetric bone density and microarchitecture as assessed by central QCT and HRpQCT in normal populations and to correlate with trabecular bone volume and cortical width measured by bone biopsy and histomorphometry in patients with chronic kidney disease . The utility of TBS in the renal transplant population has not been explored in detail.…”

Section: Introductionmentioning

confidence: 99%

Addressing bone quality and bone density after renal transplantation: A prospective evaluation of the evolution of trabecular bone score and bone mineral density over the first 5 years following renal transplantation in Asian patients

Chandran

Ying

Kwee

et al. 2019

Clinical Transplantation

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The evolution of trabecular bone score (TBS) and bone mineral density (BMD) over the first 5 years after renal transplantation was prospectively evaluated in 164 patients. Dual energy X-ray absorptiometry (DXA) scans were performed at 0, 6, 12, 24, and 60 months. Cumulative steroid dose, serum 25(OH)D, calcium, parathyroid hormone, and total ALP levels at these time points were checked. Incident fractures were identified from X-rays/vertebral fracture assessments. Mean (SD) age, TBS, and lumbar spine BMD at baseline were 47.11 (9.53), 1.424 (0.097), and 0.935 (0.183) gm/cm 2 , respectively. Baseline TBS was lower in tertiary 1.38 (0.07) vs secondary hyperparathyroidism 1.43 (0.01) vs post-parathyroidectomy 1.46 (0.11); P = .035. Trabecular bone score and BMD significantly decreased from baseline->6 months, changes after that at consecutive time points were non-significant. 11% had incident fractures during the follow-up period, majority being metatarsal with no vertebral or hip fractures noted. This first prospective evaluation of TBS and BMD evolution at multiple time points over 5 years suggest that microarchitectural and bone density deteriorations post-renal transplantation stabilize after 6 months. Stabilization of these parameters could partially account for the absence of major fractures noted in this Asian population. Possible genetic and ethnic differences in fracture risk between Asian and Caucasian renal transplant patients have to be explored through large population-based studies. K E Y W O R D SAsian, bone mineral density, fracture, kidney transplantation, renal transplantation, trabecular bone score 2 of 9 | CHANDRAN et Al fracture rates have been claimed to be up to 34% higher in the first 2 years after transplantation compared to the previous year on dialysis. 2 Other studies have found fracture event rates ranging from 5.9 to 7.0 per 1000 years. 3 The most common sites of fracture following renal transplantation have been reported to be in the vertebrae with prevalence rates of up to 38.5% on average follow-up of 4.6 years in one study 4 and in the feet 5 though hip fracture incidence rates of up to 3.8/1000 6 have also been reported.. The fracture incidence and prevalence rates reported following renal transplantation have exclusively been from studies conducted in western populations. In an earlier study of ours on South East Asians living in Singapore, no fractures were observed in the first year following renal transplantation. 7Whether or not these fractures that have been reported to occur, happen as a result of bone mineral density losses or due to compromised bone quality and microarchitectural changes is not clear. Bone mineral density as measured by dual energy X-ray absorptiometry (DXA) only estimates the amount of mineral but not other important key elements that contribute to bone strength such as bone microarchitecture. The only way so far to delineate bone microarchitecture is either through modalities such as micro QCT and HrPQCT with their attendant high radiation exposure, or t...

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The trabecular bone score: Relationships with trabecular and cortical microarchitecture measured by HR-pQCT and histomorphometry in patients with chronic kidney disease

Cited by 50 publications

References 41 publications

Rethinking Bone Disease in Kidney Disease

Rethinking Bone Disease in Kidney Disease

Trabecular bone score may indicate chronic kidney disease-mineral and bone disorder (CKD-MBD) phenotypes in hemodialysis patients: a prospective observational study

Addressing bone quality and bone density after renal transplantation: A prospective evaluation of the evolution of trabecular bone score and bone mineral density over the first 5 years following renal transplantation in Asian patients

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