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

Poiană, Cătălina; Duşceac, Roxana; Niculescu, D

doi:10.3389/fmed.2021.782837

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…observed that lower TBS scores were associated with lower eGFR and increased fracture risk in patients with eGFR ≥ 60 ml/min/1.73 m 2 ( 44 ). Nevertheless, the role of TBS in predicting clinical fractures in prospective studies focused on dialysis patients has not yet been demonstrated ( 45 ). However, an association with higher bone turnover and prevalent fractures has recently been evidenced in end-stage CKD and dialysis ( 40 , 46 , 47 ).…”

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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“…Thus, each decrease of 1 SD in lumbar BMD increased the age-adjusted odds ratio for VFs up to 2.0 times (1.4–2.0) while each SD decrease in total-body BMD increased it up to 1.6 times (1.1–1.6) [ 42 ]. Conversely, the TBS (which adds information on the bone trabecular microarchitecture) was not demonstrated to independently predict clinical fractures (or VFs) in prospective studies in patients with CKD who were undergoing haemodialysis [ 68 , 69 ]. However, a lower TBS was found to be significantly associated with previous non-VFs.…”

Section: Epidemiologymentioning

confidence: 99%

Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action

Gifre,

Massó,

Fusaro

et al. 2024

Clinical Kidney Journal

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Vertebral fractures (VFs) are the most common osteoporotic fractures in the general population, and they have been associated with high mortality, decreased quality of life and high risk of subsequent fractures, especially when recent, multiple or severe. Currently, VF diagnosis and classification determine fracture risk and the most appropriate anti-osteoporotic treatment. However, VFs are clearly underdiagnosed, especially in patients with chronic kidney disease (CKD), and CKD-associated osteoporosis has been disregarded until recently. VFs are associated with higher morbidity and mortality, and their prevalence and incidence differ depending on the grade of renal dysfunction (CKD G1–G5) and/or the type of renal replacement therapy (dialysis or transplantation). In addition to classical risk factors [such as higher age, female sex, reduced bone mineral density (BMD), diabetes and steroid use], various other factors have been associated with an increased risk of VFs in CKD, including CKD grade, haemodialysis vintage, time since renal transplantation, low or high intact parathyroid hormone and phosphate levels, and/or vitamin D and K1 deficiencies. Importantly, several clinical societies have recently modified their algorithms according to the fracture risk classification (including the presence of VFs) and determined the most appropriate anti-osteoporotic treatment for the general population. However, there are no specific guidelines addressing this topic in patients with CKD despite an important paradigm shift regarding the prognostic value of BMD in 2017 after the publication of the CKD-Mineral and Bone Disorder (CKD-MBD) KDIGO guidelines. A proactive attitude towards diagnosis, treatment and research is proposed to avoid therapeutic nihilism.

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“…Over a period of 5 years, the risk for fracture was not different in individuals with eGFR <60 mL/min/1.73 m 2 compared with those with an eGFR > 60 mL/min/1.73 m 2 . The trabecular bone score (TBS) is a DEXA-derived algorithm for the evaluation of bone microarchitecture whose utility in patient with osteoporosis has been largely demonstrated [ 48 , 114 , 115 ]. Studies have shown that TBS may also be useful to measure bone quality in patients with CKD-MBD [ 114 , 116 ].…”

Section: Bone Fracture In Ckdmentioning

confidence: 99%

“…The trabecular bone score (TBS) is a DEXA-derived algorithm for the evaluation of bone microarchitecture whose utility in patient with osteoporosis has been largely demonstrated [ 48 , 114 , 115 ]. Studies have shown that TBS may also be useful to measure bone quality in patients with CKD-MBD [ 114 , 116 ]. Indeed, in CKD patient, TBS was significantly associated with the histologic parameters of trabecular bone volume and trabecular spacing but not with dynamic parameters, suggesting that TBS reflects trabecular microarchitecture and cortical width [ 117 ].…”

Section: Bone Fracture In Ckdmentioning

confidence: 99%

Bone Disease in Chronic Kidney Disease and Kidney Transplant

2022

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Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) comprises alterations in calcium, phosphorus, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor-23 (FGF-23) metabolism, abnormalities in bone turnover, mineralization, volume, linear growth or strength, and vascular calcification leading to an increase in bone fractures and vascular disease, which ultimately result in high morbidity and mortality. The bone component of CKD-MBD, referred to as renal osteodystrophy, starts early during the course of CKD as a result of the effects of progressive reduction in kidney function which modify the tight interaction between mineral, hormonal, and other biochemical mediators of cell function that ultimately lead to bone disease. In addition, other factors, such as osteoporosis not apparently dependent on the typical pathophysiologic abnormalities resulting from altered kidney function, may accompany the different varieties of renal osteodystrophy leading to an increment in the risk of bone fracture. After kidney transplantation, these bone alterations and others directly associated or not with changes in kidney function may persist, progress or transform into a different entity due to new pathogenetic mechanisms. With time, these alterations may improve or worsen depending to a large extent on the restoration of kidney function and correction of the metabolic abnormalities developed during the course of CKD. In this paper, we review the bone lesions that occur during both CKD progression and after kidney transplant and analyze the factors involved in their pathogenesis as a means to raise awareness of their complexity and interrelationship.

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

Cited by 7 publications

References 38 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

Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action

Bone Disease in Chronic Kidney Disease and Kidney Transplant

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