Inverse association between bone microarchitecture assessed by HR-pQCT and coronary artery calcification in patients with end-stage renal disease.
It is a matter of debate whether vascular calcification and bone loss are simultaneously occurring but largely independent processes or whether poor bone health predisposes to vascular calcification, especially in patients with kidney disease. Here we investigated the association between the changes of microarchitecture in weight bearing bone and the extent of coronary artery calcification in patients with chronic renal failure. The bone microarchitecture of the tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT), bone mineral density using dual X-ray absorptiometry (DXA) of the lumbar spine, femoral neck and distal radius as well as coronary artery calcification using multi-slice CT and reported as Agatston score were measured in 66 patients with end-stage renal disease on chronic hemodialysis. Markers of bone turnover, vitamin D status and intact parathyroid hormone (iPTH) were assessed. CAC score was found to be <100 in 39% and ≥100 in 61% of patients. The median [95% CI] total CAC score was 282 [315-2587]. By univariate analysis, significant correlations between CAC and age (R=0.52, p<0.001), weight (R=0.3, p<0.01) and serum cross laps (CTX, R=-0.39, p<0.01) were found, and parameters of bone microarchitecture were numerically but not significantly lower in patients with CAC scores ≥100. In multivariate analysis stratifying for gender and correcting for age, tibial density (Dtot) and bone volume/total volume (BV/TV) were significantly lower in patients with CAC scores ≥100 (p<0.05 for both). Low trabecular bone volume and decreased cortical bone density are associated with coronary artery calcification in dialysis patients.
Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria. Electronic address: daniel.cejka@meduniwien.ac.at.
Daniel
D
Cejka
Medical University Vienna, Vienna, Austria; Department of Radiology, Medical University Vienna, Vienna, Austria. Electronic address: michael.weber@meduniwien.ac.at.
Michael
M
Weber
Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria. Electronic address: danielle.diarra@meduniwien.ac.at.
Danielle
D
Diarra
Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria. Electronic address: thomas.reiter@meduniwien.ac.at.
Thomas
T
Reiter
Medical University Vienna, Vienna, Austria; Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University Vienna, Vienna, Austria. Electronic address: franz.kainberger@meduniwien.ac.at.
Franz
F
Kainberger
Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria. Electronic address: martin.haas@meduniwien.ac.at.
Martin
M
Haas
D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*
Dialysis; High-resolution peripheral quantitative computed tomography; Renal osteodystrophy; Vascular calcification