Journal
JOURNAL OF BONE AND MINERAL RESEARCH
Volume 30, Issue 5, Pages 913-919Publisher
WILEY
DOI: 10.1002/jbmr.2406
Keywords
BONE MINERAL DENSITY; DXA; HRPQCT; FRACTURES; CHRONIC KIDNEY DISEASE
Categories
Funding
- Canadian Institutes of Health Research [FRN: 93785]
- Physicians Services Incorporated Foundation
- Kidney Foundation of Canada
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Fractures are common in chronic kidney disease (CKD). The optimal methods by which to assess fracture risk are unknown, in part, due to a lack of prospective studies. We determined if bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and/or high-resolution peripheral quantitative computed tomography (HRpQCT) could predict fractures in men and women 18 years old with stages 3 to 5 CKD. BMD was measured by DXA (at the total hip, lumbar spine, ultradistal, and 1/3 radius) and by HRpQCT (at the radius), and subjects were followed for 2 years for incident morphometric spine fractures and low-trauma clinical fractures. The mean age of the subjects was 62 years with equal numbers having stages 3, 4, and 5 CKD. Over 2 years there were 51 fractures in 35 subjects. BMD by DXA at baseline was significantly lower at all sites among those with incident fractures versus those without. For example, the mean BMD at the total hip in those with incident fractures was 0.77g/cm(2) (95% confidence interval [CI], 0.73 to 0.80) and in those without fracture was 0.95g/cm(2) (95% CI, 0.92 to 0.98). Almost all baseline HRpQCT measures were lower in those with incident fracture versus those without. For example, volumetric BMD in those with incident fractures was 232mg HA/cm(3) (95% CI, 213 to 251) and in those without fracture was 317.6mg HA/cm(3) (95% CI, 306 to 329.1). Bone loss occurred in all subjects, but was significantly greater among those with incident fractures. Our data demonstrate that low BMD (by DXA and HRpQCT) and a greater annualized percent decrease in BMD are risk factors for subsequent fracture in men and women with predialysis CKD. (c) 2014 American Society for Bone and Mineral Research.
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