Trabecular bone score in patients with chronic kidney disease

Area of Science:

• Nephrology
• Orthopedics
• Radiology

Background:

• Patients with chronic kidney disease (CKD) face a heightened risk of osteoporotic fractures.
• Trabecular bone score (TBS) is a skeletal imaging feature that may offer insights into fracture risk.

Purpose of the Study:

• To evaluate if Trabecular bone score (TBS) independently or adjusted for FRAX predicts major osteoporotic fractures (MOFs) in CKD patients.
• To assess the association between TBS, kidney function, and fracture risk across all stages of CKD.

Main Methods:

• Utilized population-based administrative databases to identify 8289 patients aged over 20 with DXA and serum creatinine.
• Excluded patients on dialysis or with renal transplants, stratifying by estimated glomerular filtration rate (eGFR).
• Collected data on bone mineral density (BMD), TBS, MOFs, and hip fractures.

Main Results:

• Lower TBS scores correlated with increased MOF and hip fracture risk across all eGFR strata in unadjusted models.
• After adjusting for FRAX and BMD, lower TBS remained a significant predictor only for MOF in patients with eGFR ≥ 60 mL/min/1.73 m².
• Lower TBS was associated with poorer kidney function (lower eGFR).

Conclusions:

• Lower TBS scores are associated with reduced kidney function and increased fracture risk in CKD patients with eGFR ≥ 60 mL/min/1.73 m².
• Incorporating TBS into the FRAX score with BMD did not significantly enhance fracture risk prediction in the overall CKD population.