Evaluation of Bone Microarchitecture by High-resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Hemodialysis Patients

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2012 Jan 12

PMID 22234812

Citations 24

Authors

A L Negri

E E Del Valle

M B Zanchetta

M Nobaru

F Silveira

M Puddu

R Barone

C E Bogado

J R Zanchetta

Affiliations

Soon will be listed here.

Abstract

Unlabelled: Hemodialyzed patients have decreased bone strength not completely characterized. We evaluated bone microarchitecture in hemodialysis patients and compared it to that of subjects without renal disease by high-resolution peripheral quantitative computed tomography (HR-pQCT). Hemodialysis patients have a marked decreased in cortical density, thickness, and area with significant reduction in trabecular parameters that correlated with the severity of secondary hyperparathyroidism only in women.

Introduction: Although fracture risk is greatly increased in dialysis patients, the corresponding decreased in bone strength has not been completely characterized.

Methods: We evaluated volumetric bone mineral density (vBMD) and bone microstructure by HR-pQCT at the distal radius and tibia in 50 hemodialyzed (HD) patients (30 females, mean age 53.2 ± 6 years and 20 males, mean age 59.1 ± 11 years) and 50 sex- and age-matched controls.

Results: At the distal radius HD, women showed a 29% reduction in total and trabecular density and trabecular bone volume fraction (p < 0.0001) compared to controls. Trabecular number was reduced by 25% (p < 0.0001), while trabecular separation was increased by 51%. Cortical thickness (-40%, p < 0.0001) and cortical area (-42%, p < 0.0001) were the parameters most reduced, while compact density was the parameter least reduced (-15%, p < 0.0001). Similar findings were found at the tibia. In HD men, HR-pQCT at the distal radius and tibia showed a reduction in volumetric density and microstructure parameters to a lesser extent than in women. In the hemodialyzed group, cortical thickness at the radius was negatively correlated with age both in women and men. At the distal radius and tibia, we found significant negative correlations between Log iPTH and total alkaline phosphatase with cortical vBMD(r = -0.48, p < 0.01; r = -0.69, p < 0.001), thickness (-0.37, p < 0.05; r = -0.60, p < 0.001), and area ((r = -0.43, p = 0.02; r = -0.65, p < 0.001) but only in women.

Conclusion: We conclude that hemodialysis patients have a marked decreased in cortical density, thickness, and area with significant reduction in trabecular parameters that correlated with the severity of secondary hyperparathyroidism only in women.

Citing Articles

Study of distribution and morphological characteristics of the trabecular bone in the uncinate process of the cervical spine using micro-computed tomography.

Hao Y, Ma Y, Zhang S, Wang C, Wang W, Li X PLoS One. 2025; 20(1):e0315640.

PMID: 39752465 PMC: 11698431. DOI: 10.1371/journal.pone.0315640.

Lower Parathyroid Hormone Levels are Associated With Reduced Fracture Risk in Japanese Patients on Hemodialysis.

Komaba H, Imaizumi T, Hamano T, Fujii N, Abe M, Hanafusa N Kidney Int Rep. 2024; 9(10):2956-2969.

PMID: 39430172 PMC: 11489479. DOI: 10.1016/j.ekir.2024.07.008.

Patellar and quadriceps tendon rupture are associated with hip fracture in hemodialysis patients with severe hyperparathyroidism.

Pichone A, Juvencio E, Crespo B, Gomes C, Mendes R, Godinho M JBMR Plus. 2024; 8(2):ziae008.

PMID: 38505521 PMC: 10945730. DOI: 10.1093/jbmrpl/ziae008.

Management of fracture risk in CKD-traditional and novel approaches.

Haarhaus M, Aaltonen L, Cejka D, Cozzolino M, de Jong R, DHaese P Clin Kidney J. 2023; 16(3):456-472.

PMID: 36865010 PMC: 9972845. DOI: 10.1093/ckj/sfac230.

Bone Disease in Chronic Kidney Disease and Kidney Transplant.

Bellorin-Font E, Rojas E, Martin K Nutrients. 2023; 15(1).

PMID: 36615824 PMC: 9824497. DOI: 10.3390/nu15010167.

References

Hildebrand T, Ruegsegger P . Quantification of Bone Microarchitecture with the Structure Model Index. Comput Methods Biomech Biomed Engin. 1997; 1(1):15-23. DOI: 10.1080/01495739708936692. View

Yamaguchi T, Kanno E, Tsubota J, Shiomi T, Nakai M, Hattori S . Retrospective study on the usefulness of radius and lumbar bone density in the separation of hemodialysis patients with fractures from those without fractures. Bone. 1996; 19(5):549-55. DOI: 10.1016/s8756-3282(96)00246-3. View

Crabtree N, Loveridge N, Parker M, Rushton N, Power J, Bell K . Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res. 2001; 16(7):1318-28. DOI: 10.1359/jbmr.2001.16.7.1318. View

Atsumi K, Kushida K, Yamazaki K, Shimizu S, Ohmura A, Inoue T . Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis. 1999; 33(2):287-93. DOI: 10.1016/s0272-6386(99)70302-1. View

Augat P, Reeb H, Claes L . Prediction of fracture load at different skeletal sites by geometric properties of the cortical shell. J Bone Miner Res. 1996; 11(9):1356-63. DOI: 10.1002/jbmr.5650110921. View

London G, Marchais S, Guerin A, Boutouyrie P, Metivier F, de Vernejoul M . Association of bone activity, calcium load, aortic stiffness, and calcifications in ESRD. J Am Soc Nephrol. 2008; 19(9):1827-35. PMC: 2518431. DOI: 10.1681/ASN.2007050622. View

Haidekker M, Andresen R, Werner H . Relationship between structural parameters, bone mineral density and fracture load in lumbar vertebrae, based on high-resolution computed tomography, quantitative computed tomography and compression tests. Osteoporos Int. 1999; 9(5):433-40. DOI: 10.1007/s001980050168. View

Burghardt A, Buie H, Laib A, Majumdar S, Boyd S . Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT. Bone. 2010; 47(3):519-28. PMC: 2926164. DOI: 10.1016/j.bone.2010.05.034. View

Pistoia W, van Rietbergen B, Ruegsegger P . Mechanical consequences of different scenarios for simulated bone atrophy and recovery in the distal radius. Bone. 2003; 33(6):937-45. DOI: 10.1016/j.bone.2003.06.003. View

10.

Laib A, Ruegsegger P . Comparison of structure extraction methods for in vivo trabecular bone measurements. Comput Med Imaging Graph. 1999; 23(2):69-74. DOI: 10.1016/s0895-6111(98)00071-8. View

11.

Bacchetta J, Boutroy S, Juillard L, Vilayphiou N, Guebre-Egziabher F, Pelletier S . Bone imaging and chronic kidney disease: will high-resolution peripheral tomography improve bone evaluation and therapeutic management?. J Ren Nutr. 2009; 19(1):44-9. DOI: 10.1053/j.jrn.2008.10.023. View

12.

Muller M, Webber C, Bouxsein M . Predicting the failure load of the distal radius. Osteoporos Int. 2003; 14(4):345-52. DOI: 10.1007/s00198-003-1380-9. View

13.

Laib A, Hauselmann H, Ruegsegger P . In vivo high resolution 3D-QCT of the human forearm. Technol Health Care. 1999; 6(5-6):329-37. View

14.

Jamal S, Gilbert J, Gordon C, Bauer D . Cortical pQCT measures are associated with fractures in dialysis patients. J Bone Miner Res. 2006; 21(4):543-8. DOI: 10.1359/jbmr.060105. View

15.

Bacchetta J, Boutroy S, Vilayphiou N, Juillard L, Guebre-Egziabher F, Rognant N . Early impairment of trabecular microarchitecture assessed with HR-pQCT in patients with stage II-IV chronic kidney disease. J Bone Miner Res. 2009; 25(4):849-57. DOI: 10.1359/jbmr.090831. View

16.

Hasegawa K, Hasegawa Y, Nagano A . Estimation of bone mineral density and architectural parameters of the distal radius in hemodialysis patients using peripheral quantitative computed tomography. J Biomech. 2004; 37(5):751-6. DOI: 10.1016/S0021-9290(03)00174-X. View

17.

Bell K, Loveridge N, Power J, Garrahan N, Stanton M, Lunt M . Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res. 1999; 14(1):111-9. DOI: 10.1359/jbmr.1999.14.1.111. View

18.

Krug R, Burghardt A, Majumdar S, Link T . High-resolution imaging techniques for the assessment of osteoporosis. Radiol Clin North Am. 2010; 48(3):601-21. PMC: 2901255. DOI: 10.1016/j.rcl.2010.02.015. View

19.

Macneil J, Boyd S . Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys. 2007; 29(10):1096-105. DOI: 10.1016/j.medengphy.2006.11.002. View

20.

Melton 3rd L, Riggs B, van Lenthe G, Achenbach S, Muller R, Bouxsein M . Contribution of in vivo structural measurements and load/strength ratios to the determination of forearm fracture risk in postmenopausal women. J Bone Miner Res. 2007; 22(9):1442-8. DOI: 10.1359/jbmr.070514. View