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Author Spotlight: An Economic and Efficient Method for Quantitative Evaluation of Bone Microarchitecture in a Murine Osteoporosis Model
Published on: September 8, 2023
Bone microarchitecture declines in older men with impaired renal function-the prospective STRAMBO study
Audrey Bobiller1, Danielle Whittier2, Laurence Derain Dubourg3
1INSERM UMR 1033, Université de Lyon, Hôpital Edouard Herriot, 69437 Lyon, France.
Insights
Lower estimated glomerular filtration rate (eGFR) in older men is linked to faster declines in bone strength and microarchitecture. This association may explain increased fracture risk in individuals with chronic kidney disease (CKD).
Area of Science:
- Nephrology and Bone Metabolism
- Geriatric Medicine
- Radiology and Imaging
Background:
- Chronic kidney disease (CKD) is frequently associated with mineral and bone disorders (CKD-MBD).
- Limited data exist on the relationship between estimated glomerular filtration rate (eGFR) and bone microarchitecture.
- Understanding this link is crucial for assessing fracture risk in aging populations with CKD.
Purpose of the Study:
- To investigate the association between eGFR and bone microarchitecture at baseline and over time.
- To assess changes in bone structure and strength in relation to eGFR in older men.
- To explore the potential contribution of eGFR-related bone changes to fracture risk.
Main Methods:
- Longitudinal study of 826 men aged ≥60 years over 8 years.
- eGFR calculated using three established equations (CKDEPI-2012, EKFC, CKDEPI-2021).
- Bone microarchitecture assessed via high-resolution peripheral quantitative computed tomography (HR-pQCT) at distal radius and tibia.
- Bone strength estimated using microfinite element analysis; changes analyzed with linear mixed-effect models.
Main Results:
- At baseline, lower eGFR was associated with higher trabecular measures and failure load at the distal tibia.
- Over 8 years, lower eGFR correlated with accelerated decreases in bone mineral density, cortical area, and bone strength at the distal radius.
- Lower eGFR also predicted faster increases in trabecular area and heterogeneity at the distal radius, and declines in bone density and strength at the distal tibia.
Conclusions:
- Reduced eGFR is significantly associated with accelerated deterioration of cortical bone microarchitecture and reduced bone strength in older men.
- These microarchitectural changes at both the radius and tibia may underlie the elevated fracture risk observed in older adults with CKD.
- Findings highlight the importance of monitoring bone health in aging individuals with declining kidney function.
Abstract:
CKD may be complicated by mineral and bone disorders (CKD-MBD). Data on the association between estimated glomerular filtration rate (eGFR) and bone microarchitecture are limited. We studied the link between eGFR and bone microarchitecture (baseline, changes) assessed by HR-pQCT in older men followed for 8 yr. In 826 men aged ≥60, eGFR was calculated using 3 equations based on creatinin and cystatin C: CKDEPI-2012, EKFC without race and sex, and CKDEPI-2021 without race. Bone microarchitecture was assessed at the distal radius and distal tibia by HR-pQCT at baseline, then after 4 and 8 yr. Reaction force and failure load were estimated by microfinite element analysis. Changes in bone measures across the eGFR classes were explored using linear mixed effect models. At baseline, distal radius bone microarchitecture did not differ across the eGFR groups (CKDEPI-2012), whereas distal tibia trabecular measures and failure load were higher in men with decreased eGFR. During the follow-up, lower eGFR was associated with a more rapid decrease in total BMD (Tt.BMD), cortical area (Ct.Ar) and BMD (Ct.BMD), trabecular BMD (Tb.BMD), and failure load at the distal radius. Low eGFR was also associated with a faster increase in trabecular area (Tb.Ar) and trabecular distribution heterogeneity (Tb.1/N.SD). At the distal tibia, low eGFR was associated with a more rapid decrease in Tt.BMD, Ct.Ar, Ct.BMD, Tb.1/N.SD, and failure load as well as with a faster increase in Tb.Ar. The patterns were similar for changes expressed as percentages. The patterns were similar for 2 other equations. Lower eGFR is associated with a faster decline in cortical bone microarchitecture and bone strength at the distal radius and tibia in older men. This phenomenon may contribute to the higher fracture risk in older adults with CKD.
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