title: Bone microarchitecture in hemodialysis patients assessed by HR-pQCT.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
authors: Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors: Daniel
authors: D
authors: Cejka
authors: Janina M
authors: JM
authors: Patsch
authors: Michael
authors: M
authors: Weber
authors: Danielle
authors: D
authors: Diarra
authors: Markus
authors: M
authors: Riegersperger
authors: Zeljko
authors: Z
authors: Kikic
authors: Christian
authors: C
authors: Krestan
authors: Claudia
authors: C
authors: Schueller-Weidekamm
authors: Franz
authors: F
authors: Kainberger
authors: Martin
authors: M
authors: Haas
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D012372:ROC Curve; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D010281:Parathyroid Hormone