Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/29020
Title: Bone microarchitecture and estimated failure load are deteriorated whether patients with chronic kidney disease have normal bone mineral density, osteopenia or osteoporosis.
Austin Authors: Ghasem-Zadeh, Ali ;Bui, Minh;Seeman, Ego ;Boyd, Steven K;Iuliano-Burns, Sandra ;Jaipurwala, Rizwan;Mount, Peter F ;Toussaint, Nigel D;Chiang, Cherie Y 
Affiliation: Department of Nephrology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia..
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia..
Endocrinology
Medicine (University of Melbourne)
Nephrology
McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada..
Issue Date: Jan-2022
Date: 2021
Publication information: Bone 2022; 154: 116260
Abstract: Measurement of bone mineral density (BMD) is recommended in patients with chronic kidney disease (CKD). However, most persons in the community and most patients with CKD have osteopenia, suggesting fracture risk is low. Bone loss compromises bone microarchitecture which increases fragility disproportionate to modest deficits in BMD. We therefore hypothesized that patients with CKD have reduced estimated failure load due to deterioration in microarchitecture irrespective of whether they have normal femoral neck (FN) BMD, osteopenia or osteoporosis. We measured distal tibial and distal radial microarchitecture in 128 patients with CKD and 275 age- and sex-matched controls using high resolution peripheral quantitative computed tomography, FN-BMD using bone densitometry and estimated failure load at the distal appendicular sites using finite element analysis. Patients versus controls respectively had: lower tibial cortical area 219 (40.7) vs. 237 (35.3) mm2, p = 0.002, lower cortical volumetric BMD 543 (80.7) vs. 642 (81.7) mgHA/cm3 due to higher porosity 69.6 (6.19) vs. 61.9 (6.48)% and lower matrix mineral density 64.2 (0.62) vs. 65.1 (1.28)%, lower trabecular vBMD 92.2 (41.1) vs. 149 (43.0) mgHA/cm3 due to fewer and spatially disrupted trabeculae, lower FN-BMD 0.78 (0.12) vs. 0.94 (0.14) g/cm2 and reduced estimated failure load 3825 (1152) vs. 5778 (1467) N, all p < 0.001. Deterioration in microarchitecture and estimated failure load was most severe in patients and controls with osteoporosis. Patients with CKD with osteopenia and normal FN-BMD had more deteriorated tibial microarchitecture and estimated failure load than controls with BMD in the same category. In univariate analyses, microarchitecture and FN-BMD were both associated with estimated failure load. In multivariable analyses, only microarchitecture was independently associated with estimated failure load and accounted for 87% of the variance. Bone fragility is likely to be present in patients with CKD despite them having osteopenia or normal BMD. Measuring microarchitecture may assist in targeting therapy to those at risk of fracture.
URI: https://ahro.austin.org.au/austinjspui/handle/1/29020
DOI: 10.1016/j.bone.2021.116260
ORCID: 0000-0002-5284-9239
0000-0002-9692-048X
0000-0003-3900-2030
0000-0003-4669-3618
0000-0001-7637-3661
0000-0002-9392-6771
Journal: Bone
PubMed URL: 34801763
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/34801763/
Type: Journal Article
Subjects: Bone microarchitecture
Chronic kidney disease
Cortical porosity
HR-pQCT
Osteopenia
Osteoporosis
Trabecular density
Appears in Collections:Journal articles

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