Category: Calcium/Bone Disorders

TRABECULAR BONE SCORE IS LOWER IN PATIENTS ON PERMANENT HEMODIALYSIS COMPARED TO CONTROLS MATCHED FOR BONE MINERAL DENSITY

Friday, Apr 26
12:00 PM – 12:15 PM

Objective :

In the general population, bone mineral density (BMD) and trabecular bone score (TBS) are independent factors in predicting the risk of fracture. In patients on permanent hemodialysis (HD), BMD is not so useful in predicting the risk of fracture as in the general population and the value of TBS is currently unclear. Our aim was to assess lumbar spine (LS) TBS in HD patients compared with subjects with normal kidney function matched for age, sex, and LS BMD.


Methods :

We measured trabecular bone score (TBS) and bone mineral density (BMD) in 98 patients on permanent hemodialysis (HD) (42.8% males; mean age 57.5 ± 11.3 years; dialysis vintage 5.5 ± 3.8 years) assessed to our hospital between september 2017 and june 2017. We had a group of  98 control subjects  with normal kidney function, matched for sex, age (± 3 years), and LS BMD (± 0.03 g/cm2).


Results :

HD patients had significantly lower LS TBS (0.07 [95% CI 0.03-0.1]; p = 0.0004), TBS T-score (0.83 SD [95% CI 0.42-1.24]; p = 0.0001)) and TBS Z-score (0.81 SD [95% CI 0.41-1.20]; p = 0.0001) than matched controls. TBS significantly correlated with LS BMD in both HD patients (r = 0.382; p = 0.001) and controls (r = 0.36; p = 0.002). The two regression lines had similar slopes (0.3 vs. 0.28; p = 0.84) with different intercepts (0.88 vs. 0.98). TBS adjustment significantly increased the 10-year fracture risk from 3.7 to 5.3 for major osteoporotic fracture and from 0.9 to 1.5 for hip fracture.


Discussion :

TBS was significantly lower in HD patients, independent of BMD. Lower TBS reflects changes and damage in bone microarhitecture which occurs in patients on permanent hemodialisys and could explain the increased risk of fracture at these patients.Another interesting finding was the lower BMD at the FN for HD patients compared with controls. The absolute 10 year major and hip osteoporotic fracture risk was significantly increased in HD pat ients compared with controls due to lower femoral neck BMD.


Conclusion : HD patients have lower TBS than controls matched for LS BMD. Also, the magnitude of TBS reduction in HD patients is constant at any LS BMD. 

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Roxana Dusceac

Assistant Lecturer
Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

NA

Dan A. Niculescu

Assistant Lecturer
Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Bucharest, Bucuresti, Romania

NA

Madalina Sorohan

PhD Student
Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Bucuresti, Romania

NA

Ramona Dobre

PhD Student
Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Bucuresti, Romania

NA

Catalina Poiana

Professor of Endocrinology
Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

NA