title: Bone mass and microarchitecture in CKD patients with fracture.
abstract: Patients with predialysis chronic kidney disease (CKD) have increased risk for fracture, but the structural mechanisms underlying this increased skeletal fragility are unknown. We measured areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry at the spine, hip, and radius, and we measured volumetric BMD (vBMD), geometry, and microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the radius and tibia in patients with CKD: 32 with fracture and 59 without fracture. Patients with fracture had lower aBMD at the spine, total hip, femoral neck, and the ultradistal radius, the last having the strongest association with fracture. By HR-pQCT of the radius, patients with fracture had lower cortical area and thickness, total and trabecular vBMD, and trabecular number and greater trabecular separation and network heterogeneity. At the tibia, patients with fracture had significantly lower cortical area, thickness, and total and cortical density. Total vBMD at both radius and tibia most strongly associated with fracture. By receiver operator characteristic curve analysis, patients with longer duration of CKD had area under the curve of >0.75 for aBMD at both hip sites and the ultradistal radius, vBMD and geometry at the radius and tibia, and microarchitecture at the tibia. In summary, patients with predialysis CKD and fractures have lower aBMD by dual-energy x-ray absorptiometry and lower vBMD, thinner cortices, and trabecular loss by HR-pQCT. These density and structural differences may underlie the increased susceptibility to fracture among patients with CKD.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA. tln2001@columbia.edu
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Nickolas
authors.forename: Emily
authors.initials: E
authors.lastname: Stein
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.forename: Valerie
authors.initials: V
authors.lastname: Thomas
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Staron
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D002908:Chronic Disease; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D014057:Tomography, X-Ray Computed
references.citation: J Bone Miner Res. 1995 Jun;10(6):890-902
references.pmid: 7572313
references.citation: Ann Intern Med. 1999 Mar 16;130(6):461-70
references.pmid: 10075613
references.citation: J Am Soc Nephrol. 2006 Nov;17(11):3223-32
references.pmid: 17005938
references.citation: J Bone Miner Res. 2008 Nov;23(11):1741-50
references.pmid: 18665795
references.citation: Bone. 1999 Jan;24(1):35-9
references.pmid: 9916782
references.citation: Ann Intern Med. 1996 Sep 1;125(5):413-5
references.pmid: 8702093
references.citation: Phys Med Biol. 1998 Oct;43(10):2873-83
references.pmid: 9814524
references.citation: Arch Intern Med. 2007 Jan 22;167(2):133-9
references.pmid: 17242313
references.citation: Kidney Int. 2006 Jun;69(11):1945-53
references.pmid: 16641930
references.citation: Comput Med Imaging Graph. 1999 Mar-Apr;23(2):69-74
references.pmid: 10227372
references.citation: Am J Kidney Dis. 2002 Apr;39(4):843-9
references.pmid: 11920352
references.citation: Comput Methods Biomech Biomed Engin. 1997;1(1):15-23
references.pmid: 11264794
references.citation: BMJ. 1995 Feb 11;310(6976):358-63
references.pmid: 7677827
references.citation: Calcif Tissue Int. 2007 Mar;80(3):211-9
references.pmid: 17340226
references.citation: Bone. 1996 Nov;19(5):549-55
references.pmid: 8922656
references.citation: Am J Kidney Dis. 2003 Jan;41(1):1-12
references.pmid: 12500213
references.citation: Am J Kidney Dis. 2008 Jan;51(1):38-44
references.pmid: 18155531
references.citation: Technol Health Care. 1998 Dec;6(5-6):329-37
references.pmid: 10100936
references.citation: Intensive Care Med. 2003 Jul;29(7):1043-51
references.pmid: 12734652
references.citation: J Bone Miner Res. 2006 Apr;21(4):543-8
references.pmid: 16598374
references.citation: J Bone Miner Res. 2010 Apr;25(4):849-57
references.pmid: 19775204
references.citation: J Clin Endocrinol Metab. 1990 Apr;70(4):930-8
references.pmid: 2318948
references.citation: J Bone Miner Res. 2005 Dec;20(12):2105-15
references.pmid: 16294264
references.citation: J Bone Miner Res. 2009 Apr;24(4):737-43
references.pmid: 19113929
references.citation: J Bone Miner Res. 1992 Jun;7(6):633-8
references.pmid: 1414481
references.citation: Osteoporos Int. 2007 Jan;18(1):59-68
references.pmid: 17013567
references.citation: Med Eng Phys. 2007 Dec;29(10):1096-105
references.pmid: 17229586
references.citation: J Bone Miner Res. 2007 Sep;22(9):1442-8
references.pmid: 17539738
references.citation: J Bone Miner Res. 1999 Jul;14(7):1167-74
references.pmid: 10404017
references.citation: Osteoporos Int. 2010 Feb;21(2):263-73
references.pmid: 19455271
references.citation: Lancet. 1993 Jan 9;341(8837):72-5
references.pmid: 8093403
references.citation: J Bone Miner Res. 2008 Mar;23(3):392-9
references.pmid: 17997712
references.citation: J Bone Miner Res. 1993 Oct;8(10):1227-33
references.pmid: 8256660
references.citation: J Bone Miner Res. 2007 Apr;22(4):503-8
references.pmid: 17243862
references.citation: Kidney Int. 2008 Sep;74(6):721-31
references.pmid: 18563052
references.citation: J Bone Miner Res. 2009 Dec;24(12):1953-9
references.pmid: 20001598
references.citation: Kidney Int. 2000 Jul;58(1):396-9
references.pmid: 10886587
references.citation: Osteoporos Int. 2005 Feb;16(2):198-203
references.pmid: 15221207
references.citation: J Am Soc Nephrol. 2007 Jan;18(1):282-6
references.pmid: 17167115
references.citation: Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
references.pmid: 11904577
references.citation: J Clin Endocrinol Metab. 2005 Dec;90(12):6508-15
references.pmid: 16189253
references.citation: Am J Kidney Dis. 2007 May;49(5):674-81
references.pmid: 17472850
references.citation: J Bone Miner Res. 2010 Apr;25(4):746-56
references.pmid: 19775199
references.citation: J Clin Endocrinol Metab. 2009 Nov;94(11):4351-60
references.pmid: 19837923
references.citation: Science. 1988 Jun 3;240(4857):1285-93
references.pmid: 3287615
references.citation: Nephrol Dial Transplant. 2003 Nov;18(11):2325-31
references.pmid: 14551361
references.citation: Osteoporos Int. 2010 Jul;21(7):1161-9
references.pmid: 19714390
references.citation: J Bone Miner Metab. 2009;27(2):217-23
references.pmid: 19172222