RT Journal Article
SR Electronic
T1 Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT
JF Clinical Journal of the American Society of Nephrology
JO CLIN J AM SOC NEPHROL
FD American Society of Nephrology
SP 2264
OP 2271
DO 10.2215/CJN.09711010
VO 6
IS 9
A1 Cejka, Daniel
A1 Patsch, Janina M.
A1 Weber, Michael
A1 Diarra, Danielle
A1 Riegersperger, Markus
A1 Kikic, Zeljko
A1 Krestan, Christian
A1 Schueller-Weidekamm, Claudia
A1 Kainberger, Franz
A1 Haas, Martin
YR 2011
UL http://cjasn.asnjournals.org/content/6/9/2264.abstract
AB Background and objectives Dialysis patients are at high risk for low-trauma bone fracture. Bone density measurements using dual-energy x-ray absorptiometry (DXA) do not reliably differentiate between patients with and without fractures. The aim of this study was to identify differences in bone microarchitecture between patients with and without a history of fracture using high-resolution peripheral quantitative computed tomography (HR-pQCT). Design, setting, participants, & measurements Seventy-four prevalent hemodialysis patients were recruited for measurements of areal bone mineral density (aBMD) by DXA and bone microarchitecture by HR-pQCT. Patients with a history of trauma-related fracture were excluded. Forty healthy volunteers served as controls. Blood levels of parathyroid hormone, vitamin D, and markers of bone turnover were determined. Results Dialysis patients, particularly women, had markedly impaired bone microarchitecture. Patients with fractures had significantly reduced cortical and trabecular microarchitecture compared with patients without fractures. aBMD tended to be lower in patients with fractures, but differences were statistically not significant. The strongest determinant of fracture was the HR-pQCT-measured trabecular density of the tibia, which also had the highest discriminatory power to differentiate patients according to fracture status. Radial DXA had a lower discriminatory power than trabecular density. Conclusions Bone microarchitecture is severely impaired in dialysis patients and even more so in patients with a history of fracture. HR-pQCT can identify dialysis patients with a history of low-trauma fracture.