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.