Usefulness of the trabecular bone score in maintenance dialysis patients : A single center observational study

Oliver Malle; Markus Bergthaler; Peter Krisper; Karin Amrein; Hans Peter Dimai; Alexander H Kirsch; Alexander R Rosenkranz; Thomas Pieber; Barbara Obermayer-Pietsch; Astrid Fahrleitner-Pammer

doi:10.1007/s00508-022-02011-4

Usefulness of the trabecular bone score in maintenance dialysis patients : A single center observational study

Wien Klin Wochenschr. 2022 Jun;134(11-12):442-448. doi: 10.1007/s00508-022-02011-4. Epub 2022 Mar 9.

Affiliations

¹ Department of Internal Medicine, Div. of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria. oliver.malle@medunigraz.at.
² Department of Internal Medicine, Div. of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
³ Department of Internal Medicine, Div. of Nephrology, Medical University of Graz, Graz, Austria.

Abstract

Background: The number of dialysis patients is steadily increasing. Associated comorbidities include impaired bone and mineral metabolism, termed chronic kidney disease-mineral and bone disorder (CKD-MBD), leading to a high fracture risk, increased morbidity and mortality and impaired quality of life. While the bone density is assessed with dual-energy X‑ray absorptiometry (DXA), the trabecular bone score (TBS) captures the image texture as a potential index of skeletal microarchitecture. The aim of this study was to evaluate the clinical relevance of DXA and TBS in dialysis patients with and without prevalent fractures.

Methods: Bone disorders were evaluated in 82 dialysis patients (37% female) at the University Hospital of Graz, Austria, by DXA including the assessment of the TBS based on a patient interview and the local routine patient database software. The patient cohort was stratified by having sustained a fragility fracture in the past or not. Descriptive statistics, t‑tests for continuous variables and χ²-tests for nominal variables including results of DXA and TBS were performed to compare these groups considering the dialysis modality and duration as well as the number of kidney transplantations.

Results: Of the 82 patients, 32 (39%) had a positive history of fractures. There was a significant association between dialysis duration and fracture prevalence (p < 0.05) as well as musculoskeletal pain (p < 0.01). No significant correlation between DXA/TBS parameters and musculoskeletal pain could be established. The DXA scores did not correlate with fracture prevalence with the exception of DXA radius measurements; however, fracture prevalence significantly correlated inversely with TBS (p < 0.001).

Conclusion: The use of DXA has a limited role in fracture prediction in dialysis patients; however, the TBS seems to add information as an additional tool for fracture risk estimation in this patient population.

Keywords: Bone imaging; Bone microarchitecture; Chronic kidney disease; Mineral and bone disorder; Osteoporosis.

Publication types

Observational Study

MeSH terms

Absorptiometry, Photon / methods
Bone Density
Cancellous Bone / diagnostic imaging
Female
Humans
Lumbar Vertebrae
Male
Musculoskeletal Pain*
Osteoporotic Fractures*
Quality of Life
Renal Dialysis