Frequency of Bone Mineral Density Testing in Adult Kidney Transplant Recipients from Ontario, Canada: a Population-based Cohort Study

Overview

Journal Can J Kidney Health Dis

Publisher Sage Publications

Date 2016 Jan 19

PMID 26779343

Citations 2

Authors

Kyla L Naylor

Guangyong Zou

William D Leslie

Eric McArthur

Ngan N Lam

Gregory A Knoll

S Joseph Kim

Lisa-Ann Fraser

Jonathan D Adachi

Anthony B Hodsman

Amit X Garg

Affiliations

Soon will be listed here.

Abstract

Background: We lack consensus on the clinical value, frequency, and timing of bone mineral density (BMD) testing in kidney transplant recipients. This study sought to determine practice patterns in BMD testing across kidney transplant centres in Ontario, Canada, and to compare the frequency of testing in kidney transplant recipients to non-transplant reference groups.

Methods: Using healthcare databases from Ontario, Canada we conducted a population-based cohort study of adult kidney transplant recipients who received a transplant from 1994-2009. We used logistic regression to determine if there was a statistically significant difference across transplant centres in the decision to perform at least one BMD test after transplantation, adjusting for covariates that may influence a physician's decision to order a BMD test. We used the McNemar's test to compare the number of recipients who had at least one BMD test to non-transplant reference groups (matching on age, sex, and date of cohort entry).

Results: In the first 3 years after transplant, 4821 kidney transplant recipients underwent 4802 BMD tests (median 1 test per recipient, range 0 to 6 tests), costing $600,000 (2014 CAD equivalent dollars). Across the six centres, the proportion of recipients receiving at least one BMD test varied widely (ranging from 15.6 to 92.1 %; P < 0.001). Over half (58 %) of the recipients received at least one BMD test post-transplant, a value higher than two non-transplant reference groups (general population with a previous non-vertebral fracture [hip, forearm, proximal humerus], 13.8 %; general population with no previous non-vertebral fracture, 8.5 %; P value <0.001 for each of the comparisons).

Conclusions: There is substantial practice variability in BMD testing after transplant. New high-quality information is needed to inform the utility, optimal timing, and frequency of BMD testing in kidney transplant recipients.

Citing Articles

Relation of testosterone level and other factors with bone mineral density in male kidney transplant recipients: a cross-sectional study.

Naga Y, Sharaki O, Azzam E, Farag E, Zeid M BMC Nephrol. 2023; 24(1):271.

PMID: 37710199 PMC: 10502991. DOI: 10.1186/s12882-023-03318-8.

Canadian Society of Nephrology Commentary on the Kidney Disease Improving Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder.

Holden R, Mustafa R, Alexander R, Battistella M, Bevilacqua M, Knoll G Can J Kidney Health Dis. 2020; 7:2054358120944271.

PMID: 32821415 PMC: 7412914. DOI: 10.1177/2054358120944271.

References

Hans D, Goertzen A, Krieg M, Leslie W . Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res. 2011; 26(11):2762-9. DOI: 10.1002/jbmr.499. View

Papaioannou A, Morin S, Cheung A, Atkinson S, Brown J, Feldman S . 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010; 182(17):1864-73. PMC: 2988535. DOI: 10.1503/cmaj.100771. View

Durieux S, Mercadal L, Orcel P, Dao H, Rioux C, Bernard M . Bone mineral density and fracture prevalence in long-term kidney graft recipients. Transplantation. 2002; 74(4):496-500. DOI: 10.1097/00007890-200208270-00011. View

Naylor K, Leslie W, Hodsman A, Rush D, Garg A . FRAX predicts fracture risk in kidney transplant recipients. Transplantation. 2014; 97(9):940-5. DOI: 10.1097/01.TP.0000438200.84154.1a. View

Grotz W, Mundinger F, Gugel B, Exner V, Kirste G, Schollmeyer P . Bone fracture and osteodensitometry with dual energy X-ray absorptiometry in kidney transplant recipients. Transplantation. 1994; 58(8):912-5. DOI: 10.1097/00007890-199410270-00009. View

Moyer V . Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012; 157(2):120-34. DOI: 10.7326/0003-4819-157-2-201207170-00459. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Marshall D, Johnell O, Wedel H . Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996; 312(7041):1254-9. PMC: 2351094. DOI: 10.1136/bmj.312.7041.1254. View

Hillier T, Stone K, Bauer D, Rizzo J, Pedula K, Cauley J . Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. Arch Intern Med. 2007; 167(2):155-60. DOI: 10.1001/archinte.167.2.155. View

10.

Akaberi S, Simonsen O, Lindergard B, Nyberg G . Can DXA predict fractures in renal transplant patients?. Am J Transplant. 2008; 8(12):2647-51. DOI: 10.1111/j.1600-6143.2008.02423.x. View

11.

Ramsey-Goldman R, Dunn J, Dunlop D, Stuart F, Abecassis M, Kaufman D . Increased risk of fracture in patients receiving solid organ transplants. J Bone Miner Res. 1999; 14(3):456-63. DOI: 10.1359/jbmr.1999.14.3.456. View

12.

Carlini R, Rojas E, Weisinger J, Lopez M, Martinis R, Arminio A . Bone disease in patients with long-term renal transplantation and normal renal function. Am J Kidney Dis. 2000; 36(1):160-6. DOI: 10.1053/ajkd.2000.8289. View

13.

Grossman J, Gordon R, Ranganath V, Deal C, Caplan L, Chen W . American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010; 62(11):1515-26. DOI: 10.1002/acr.20295. View

14.

Naylor K, Garg A, Hodsman A, Rush D, Leslie W . Long-term changes in bone mineral density in kidney transplant recipients. Transplantation. 2014; 98(12):1279-85. DOI: 10.1097/TP.0000000000000284. View

15.

Iimori S, Mori Y, Akita W, Kuyama T, Takada S, Asai T . Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study. Nephrol Dial Transplant. 2011; 27(1):345-51. DOI: 10.1093/ndt/gfr317. View

16.

. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009; (113):S1-130. DOI: 10.1038/ki.2009.188. View

17.

Johnell O, Kanis J, Oden A, Johansson H, De Laet C, Delmas P . Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005; 20(7):1185-94. DOI: 10.1359/JBMR.050304. View

18.

Rabier B, Heraud A, Grand-Lenoir C, Winzenrieth R, Hans D . A multicentre, retrospective case-control study assessing the role of trabecular bone score (TBS) in menopausal Caucasian women with low areal bone mineral density (BMDa): Analysing the odds of vertebral fracture. Bone. 2009; 46(1):176-81. DOI: 10.1016/j.bone.2009.06.032. View

19.

Abbott K, Oglesby R, Hypolite I, Kirk A, Ko C, Welch P . Hospitalizations for fractures after renal transplantation in the United States. Ann Epidemiol. 2001; 11(7):450-7. DOI: 10.1016/s1047-2797(01)00226-5. View

20.

Vautour L, Melton 3rd L, Clarke B, Achenbach S, Oberg A, McCarthy J . Long-term fracture risk following renal transplantation: a population-based study. Osteoporos Int. 2003; 15(2):160-7. DOI: 10.1007/s00198-003-1532-y. View