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Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Femoral bone mineral density reflects histologically determined cortical bone volume in hemodialysis patients
T Adragao1, J Herberth, M-C Monier-Faugere
1Nephrology Department, Santa Cruz Hospital, Lisbon, Portugal.
Insights
Dual energy X-ray absorptiometry (DXA) of the femur (f-BMD) is linked to cortical bone porosity in hemodialysis (HD) patients. Lumbar bone mineral density (l-BMD) is less reliable for assessing bone volume in this population.
Area of Science:
- Bone biology and mineral metabolism
- Nephrology and dialysis patient care
- Medical imaging and diagnostics
Background:
- Assessing bone mass is crucial in chronic kidney disease (CKD) due to links with fractures and vascular calcifications.
- Dual energy X-ray absorptiometry (DXA) is a noninvasive method for bone mass assessment, with lumbar results reflecting cancellous bone and femoral results reflecting cortical bone.
- Bone histology provides direct measurements of cancellous and cortical bone volume.
Purpose of the Study:
- To evaluate the association between DXA measurements and histologically determined bone volumes.
- To assess the impact of vascular calcifications and demographic variables on these associations in hemodialysis (HD) patients.
Main Methods:
- 38 HD patients underwent DXA scans for bone mass assessment.
- Anterior iliac crest bone biopsies were obtained for histological bone volume analysis.
- Multislice computed tomography was used to quantify vascular calcifications.
Main Results:
- Lumbar bone mineral density (l-BMD) by DXA did not correlate with histologically measured cancellous bone volume.
- Femoral bone mineral density (f-BMD) by DXA showed a significant association with cortical porosity (P = 0.005) after controlling for age and dialysis duration.
- Coronary Agatson score had a borderline association with cancellous bone volume (P = 0.055).
Conclusions:
- Lumbar bone mineral density (l-BMD) has limited utility in predicting bone volume in HD patients, likely due to soft tissue calcification interference.
- Femoral bone mineral density (f-BMD) is a significant indicator of cortical porosity in this patient group.
Unlabelled:
We evaluated the associations between dual energy X-ray absorptiometry (DXA) and histologically determined cancellous and cortical bone volume by controlling for vascular calcifications and demographic variables in hemodialysis (HD) patients. Femoral bone mineral density (f-BMD) was associated with cortical porosity.
Introduction:
Assessment of bone mass in chronic kidney disease patients is of clinical importance because of the association between low bone volume, fractures, and vascular calcifications. DXA is used for noninvasive assessment of bone mass whereby vertebral results reflect mainly cancellous bone and femoral results reflect mainly cortical bone. Bone histology allows direct measurements of cancellous and cortical bone volume. The present study evaluates the association between DXA and histologically determined cancellous and cortical bone volumes in HD patients.
Methods:
In 38 HD patients, DXA was performed for assessment of bone mass, anterior iliac crest bone biopsies for bone volume, and multislice computed tomography for vascular calcifications.
Results:
While lumbar bone mineral density (l-BMD) by DXA was not associated with histologically measured cancellous bone volume, coronary Agatson score showed a borderline statistically significant association (P = 0.055). When controlled for age and dialysis duration, f-BMD by DXA was associated with cortical porosity determined by histology (P = 0.005).
Conclusions:
The usefulness of l-BMD for predicting bone volume is limited most probably because of interference by soft tissue calcifications. In contrast, f-BMD shows significant association with cortical porosity.
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