title: Trabecular bone score in kidney transplant recipients.
abstract: CONCLUSIONS
  It is uncertain whether bone mineral density (BMD) can accurately predict fracture in kidney transplant recipients. Trabecular bone score (TBS) provides information independent of BMD. Kidney transplant recipients had abnormal bone texture as measured by lumbar spine TBS, and a lower TBS was associated with incident fractures in recipients.
  
  
  BACKGROUND
  Trabecular bone score (TBS) is a texture measure derived from dual energy X-ray absorptiometry (DXA) lumbar spine images, providing information independent of bone mineral density. We assessed characteristics associated with TBS and fracture outcomes in kidney transplant recipients.
  
  
  METHODS
  We included 327 kidney transplant recipients from Manitoba, Canada, who received a post-transplant DXA (median 106 days post-transplant). We matched each kidney transplant recipient (mean age 45 years, 39% men) to three controls from the general population (matched on age, sex, and DXA date). Lumbar spine (L1-L4) DXA images were used to derive TBS. Non-traumatic incident fracture (excluding hand, foot, and craniofacial) (n = 31) was assessed during a mean follow-up of 6.6 years. We used multivariable linear regression models to test predictors of TBS, and multivariable Cox proportional hazard regression was used to estimate hazard ratios (HRs) per standard deviation decrease in TBS to express the gradient of risk.
  
  
  RESULTS
  Compared to the general population, kidney transplant recipients had a significantly lower lumbar spine TBS (1.365 ± 0.129 versus 1.406 ± 0.125, P < 0.001). Multivariable linear regression revealed that receipt of a kidney transplant was associated with a significantly lower mean TBS compared to controls (-0.0369, 95% confidence interval [95% CI] -0.0537 to -0.0202). TBS was associated with fractures independent of the Fracture Risk Assessment score including BMD (adjusted HR per standard deviation decrease in TBS 1.64, 95% CI 1.15-2.36).
  
  
  CONCLUSIONS
  Kidney transplant recipients had abnormal bone texture as assessed by TBS and a lower lumbar spine TBS was associated with fractures in recipients.
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), London, ON, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: K L
authors.initials: KL
authors.lastname: Naylor
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, ON, Canada.
authors.forename: L M
authors.initials: LM
authors.lastname: Lix
authors.affiliation: Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Hans
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), London, ON, Canada.|Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.|Division of Nephrology, Western University, London, ON, Canada.
authors.forename: A X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, ON, Canada.
authors.forename: D N
authors.initials: DN
authors.lastname: Rush
authors.affiliation: Division of Nephrology, Western University, London, ON, Canada.
authors.forename: A B
authors.initials: AB
authors.lastname: Hodsman
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, ON, Canada. BLESLIE@sbgh.mb.ca.
authors.forename: W D
authors.initials: WD
authors.lastname: Leslie
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D015519:Bone Density / Q000502:physiology; D000071556:Cancellous Bone / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D018570:Risk Assessment / Q000379:methods
keywords: Bone mineral density; Fracture; Kidney transplant recipient; Trabecular bone score