Heel ultrasonography is not a good screening tool for bone loss after kidney and pancreas transplantation.
BACKGROUND
Solid organ transplant recipients, particularly simultaneous pancreas kidney recipients, are at high fracture risk. We tested whether quantitative ultrasonography (QUS) of the heel predicts bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) in solid organ transplant recipients.


METHODS
Thirty-eight transplant recipients (22 Female/16 Male) were studied. Spine and hip BMD was measured with a Hologic DXA scanner. 'Stiffness' of the heel was measured with a Lunar Ultrasound densitometer and compared with BMD by DXA. Contributing factors to bone loss were also assessed.


RESULTS
Mean age was 43.1 +/- 1.3 yr. Simultaneous pancreas-kidney, kidney, and pancreas alone transplant recipients were assessed. Mean time post-transplantation was 3.0 +/- 0.6 yr. Mean DXA spine T-score was -1.15 +/- 0.22 (mean +/- SEM) and hip T-score was -1.22 +/- 0.20. There was no difference in mean T-score between women and men at the hip or spine. Mean right heel stiffness T-score was -0.97 +/- 0.25. There was no correlation between QUS and DXA at either the hip or spine in women or men. QUS had a false negative rate for identifying osteopenia or osteoporosis of 17% compared with DXA. The false positive rate for identifying osteopenia was 61%.


CONCLUSIONS
The QUS is an unacceptable tool for identifying those at risk for bone loss after kidney or pancreas transplantation.
Mack-Shipman
Lynn R
LR
Department of Internal Medicine, University of Nebraska Medical Center, 983020 Nebraska Medical Center, Omaha, NE 68198-3020, USA. lmack@unmc.edu
O'Grady
Donna M
DM
Erickson
Judi M
JM
Walker
Craig W
CW
Moore
Timothy E
TE
Burkman
Tab W
TW
Lane
James T
JT
Larsen
Jennifer L
JL
D015502:Absorptiometry, Photon; D000328:Adult; D000596:Amino Acids / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D001847:Bone Diseases / Q000000981:diagnostic imaging*; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging; D002111:Calcaneus / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000097:blood; D003720:Densitometry / Q000379:methods; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008403:Mass Screening; D010024:Osteoporosis / Q000000981:diagnostic imaging; D016035:Pancreas Transplantation; D012307:Risk Factors; D013131:Spine / Q000000981:diagnostic imaging; D014463:Ultrasonography
D000596:Amino Acids; D015415:Biomarkers; C036020:deoxypyridinoline; D003404:Creatinine