title: Bone Quality Assessment as Measured by Trabecular Bone Score in Patients With End-Stage Renal Disease on Dialysis.
abstract: Patients with end-stage renal disease (ESRD) on maintenance hemodialysis (HD) exhibit osteoporosis and increased fracture risk. Dual-energy X-ray absorptiometry scan measurements and calculation of fracture risk assessment toll score underestimate fracture risk in these patients and do not estimate bone quality. Trabecular bone score (TBS) has been recently proposed as an indirect measure of bone microarchitecture. In this study, we investigated alterations of bone quality in patients with ESRD on HD, using TBS. Fifty patients with ESRD on HD, with a mean age 62 years, and 52 healthy individuals matched for age, body mass index, and gender, were enrolled. All participants had a bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry scan at the lumbar spine, femoral neck, total hip, and 1/3 radius. TBS was evaluated using TBS iNsight. Serum fetuin-A and plasma fibroblast growth factor-23 (FGF-23) (C-terminal) were also measured. Patients on dialysis had significantly lower BMD values at all skeletal sites measured. Plasma FGF-23 levels significantly increased and serum fetuin-Α significantly decreased in patients on dialysis compared with controls. TBS was significantly reduced in patients on dialysis compared with controls (1.11 ± 0.16 vs 1.30 ± 0.13, p < 0.001, respectively) independently of age; BMD; duration of dialysis; and serum levels of alkaline phosphatase, 25-OH-vitamin D, parathyroid hormone, fetuin-A, or plasma FGF-23. Patients on HD who were diagnosed with an osteoporotic vertebral fracture had numerically lower TBS values, albeit without reaching statistical significance, compared with patients on dialysis without a fracture (1.044 ± 0.151 vs 1.124 ± 0.173, respectively, p = 0.079). Bone microarchitecture, as assessed by TBS, is significantly altered in ESRD on patients on HD independently of BMD values and metabolic changes that reflect chronic kidney disease-mineral and bone disorder.
authors.affiliation: Division of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Yavropoulou
authors.affiliation: Nephrology Division, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Vaios
authors.affiliation: 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Pikilidou
authors.affiliation: Radiology Unit AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Chryssogonidis
authors.affiliation: Radiology Unit AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Melina
authors.initials: M
authors.lastname: Sachinidou
authors.affiliation: Laboratory of Research of Musculoskeletal System "Th. Garofalidis", Medical School, KAT Hospital, University of Athens, Athens, Greece.
authors.forename: Symeon
authors.initials: S
authors.lastname: Tournis
authors.affiliation: Laboratory of Research of Musculoskeletal System "Th. Garofalidis", Medical School, KAT Hospital, University of Athens, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Makris
authors.affiliation: Division of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Kotsa
authors.affiliation: 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Daniilidis
authors.affiliation: Radiology Unit AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Afroditi
authors.initials: A
authors.lastname: Haritanti
authors.affiliation: Nephrology Division, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece. Electronic address: liakopul@otenet.gr.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Liakopoulos
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D000071556:Cancellous Bone / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging; D011884:Radius / Q000000981:diagnostic imaging; D006435:Renal Dialysis; D060749:alpha-2-HS-Glycoprotein / Q000378:metabolism
chemical_list: C556354:AHSG protein, human; C000717427:FGF23 protein, human; D060749:alpha-2-HS-Glycoprotein; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Bone mineral density; chronic kidney disease; hemodialysis; osteoporosis; trabecular bone score