Spine Trabecular Bone Score as an Indicator of Bone Microarchitecture at the Peripheral Skeleton in Kidney Transplant Recipients

Clinical journal of the American Society of Nephrology: CJASN

Matthew Luckman²  Elizabeth Shane³  Thomas L. Nickolas⁴  Sanchita Agarawal⁵  Kyle K. Nishiyama⁵  Chengchen Zhang⁵  Lucas Nikkel⁵ 

[1] and..¶Institute of Clinical Physiology, National Research Council, Pisa, Italy..**Biomedical Engineering, Columbia University, New York, New York;*Institute of Human Nutrition and Departments of..†Center of Bone Diseases, Bone and Joint Department, Medical University of Lausanne, Lausanne, Switzerland;§Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York;‖Department of Medicine, Kaiser Oakland Medical Center, Oakland, California;‡Medicine and..

关键词: renal osteodystrophy;    renal transplantation;    mineral metabolism;    Absorptiometry, Photon;    Adrenal Cortex Hormones;    Adult;    Bone Density;    Bone and Bones;    Follow-Up Studies;    Fractures, Bone;    Humans;    kidney transplantation;    Porosity;    Radius;    Spine;    Tomography;   

DOI  :  10.2215/CJN.09850916

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Studies using high-resolution peripheral quantitative computed tomography showed progressive abnormalities in cortical and trabecular microarchitecture and biomechanical competence over the first year after kidney transplantation. However, high-resolution peripheral computed tomography is a research tool lacking wide availability. In contrast, the trabecular bone score is a novel and widely available tool that uses gray-scale variograms of the spine image from dual-energy x-ray absorptiometry to assess trabecular quality. There are no studies assessing whether trabecular bone score characterizes bone quality in kidney transplant recipients.Design, settings, participants, & measurements Between 2009 and 2010, we conducted a study to assess changes in peripheral skeletal microarchitecture, measured by high-resolution peripheral computed tomography, during the first year after transplantation in 47 patients managed with early corticosteroid–withdrawal immunosuppression. All adult first-time transplant candidates were eligible. Patients underwent imaging with high-resolution peripheral computed tomography and dual-energy x-ray absorptiometry pretransplantation and 3, 6, and 12 months post-transplantation. We now test if, during the first year after transplantation, trabecular bone score assesses the evolution of bone microarchitecture and biomechanical competence as determined by high-resolution peripheral computed tomography.Results At baseline and follow-up, among the 72% and 78%, respectively, of patients having normal bone mineral density by dual-energy x-ray absorptiometry, 53% and 50%, respectively, were classified by trabecular bone score as having high fracture risk. At baseline, trabecular bone score correlated with spine, hip, and ultradistal radius bone mineral density by dual-energy x-ray absorptiometry and cortical area, density, thickness, and porosity; trabecular density, thickness, separation, and heterogeneity; and stiffness and failure load by high-resolution peripheral computed tomography. Longitudinally, each percentage increase in trabecular bone score was associated with increases in trabecular number (0.35%±1.4%); decreases in trabecular thickness (−0.45%±0.15%), separation (−0.40%±0.15%), and network heterogeneity (−0.48%±0.20%); and increases in failure load (0.22%±0.09%) by high-resolution peripheral computed tomography (all P<0.05).Conclusions Trabecular bone score may be a useful method to assess and monitor bone quality and strength and classify fracture risk in kidney transplant recipients.

【 授权许可】

CC BY