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Outer-Boundary Assisted Segmentation and Quantification of Trabecular Bones by an Imagej Plugin
Published on: March 14, 2018
Chronic hemodialysis is associated with lower trabecular bone score, independent of bone mineral density: a
Roxana Dusceac1, Dan Alexandru Niculescu2, Ramona Dobre1
1Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania.
Insights
Trabecular bone score (TBS) was significantly lower in hemodialysis (HD) patients compared to controls, indicating poorer bone microarchitecture. This finding may help explain the increased fracture risk observed in HD patients.
Area of Science:
- Nephrology
- Orthopedics
- Radiology
Background:
- Trabecular bone score (TBS) predicts fractures independently of bone mineral density (BMD) in the general population.
- The role of TBS in end-stage renal disease (ESRD) patients on hemodialysis (HD) requires further clarification.
- Altered bone microarchitecture is a concern in HD patients, potentially contributing to higher fracture rates.
Purpose of the Study:
- To compare lumbar spine (LS) TBS between HD patients and controls with normal kidney function.
- To assess if TBS provides additional fracture risk prediction beyond BMD in HD patients.
- To investigate the relationship between LS TBS and LS BMD in HD patients.
Main Methods:
- 98 HD patients and 98 matched controls (age, sex, LS BMD) were assessed using DXA.
- Lumbar spine (LS) and femoral neck (FN) BMD were measured.
- LS TBS was calculated and compared between groups, controlling for potential confounders.
Main Results:
- HD patients exhibited significantly lower LS TBS, TBS T-score, and TBS Z-score compared to matched controls.
- TBS showed a significant correlation with LS BMD in both HD patients and controls.
- Adjusting for TBS significantly increased the calculated 10-year fracture risk for major osteoporotic and hip fractures.
Conclusions:
- HD patients demonstrate reduced bone microarchitecture, as indicated by lower TBS, independent of BMD.
- The observed TBS reduction in HD patients is consistent across varying LS BMD levels.
- Incorporating TBS into fracture risk assessments may improve prediction accuracy in HD patients.
Abstract:
We measured trabecular bone score (TBS) in 98 patients on permanent hemodialysis (HD) and 98 subjects with similar bone mineral density and normal kidney function. TBS was significantly lower in HD patients, indicating deteriorated bone microarchitecture, independent of bone mass. This might partially explain the increased fracture risk in HD.
Purpose:
In the general population, trabecular bone score (TBS) was shown to predict fracture independent of bone mineral density (BMD). In end-stage renal disease patients on hemodialysis (HD), the value of TBS is beyond that of BMD in currently unclear. Our aim was to assess lumbar spine (LS) TBS in HD patients compared with subjects with normal kidney function matched for age, sex, and LS BMD.
Methods:
We assessed TBS and LS and femoral neck (FN) BMD in 98 patient on permanent HD (42.8% males; mean age 57.5 ± 11.3 years; dialysis vintage 5.5 ± 3.8 years) and 98 control subjects (glomerular filtration rate > 60 mL/min) using DXA. We simultaneously controlled for sex, age (± 3 years), and LS BMD (± 0.03 g/cm2).
Results:
HD patients had significantly lower LS TBS (0.07 [95% CI 0.03-0.1]; p = 0.0004), TBS T-score (0.83 SD [95% CI 0.42-1.24]; p = 0.0001)) and TBS Z-score (0.81 SD [95% CI 0.41-1.20]; p = 0.0001) than matched controls. TBS significantly correlated with LS BMD in both HD patients (r = 0.382; p = 0.001) and controls (r = 0.36; p = 0.002). The two regression lines had similar slopes (0.3 vs. 0.28; p = 0.84) with different intercepts (0.88 vs. 0.98). TBS adjustment significantly increased the 10-year fracture risk from 3.7 to 5.3 for major osteoporotic fracture and from 0.9 to 1.5 for hip fracture.
Conclusions:
HD patients have lower TBS than controls matched for LS BMD, indicating altered bone microarchitecture. Also, the magnitude of TBS reduction in HD patients is constant at any LS BMD. Adjustment for TBS partially corrects the absolute 10-year fracture risk.
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