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Trabecular bone score better predicts fracture risk vs. BMD after hemodialysis

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LOS ANGELES — Adults on permanent hemodialysis have a lower lumbar spine trabecular bone score, independent of bone mineral density score, when compared with healthy controls, likely explaining the increased risk for osteoporotic fracture observed in these patients, according to study data presented here.

Roxana Dusceac

“In the general population, BMD and [trabecular bone score] are independent factors in predicting the risk for fracture,” Roxana Dusceac, MD, a doctoral student and assistant lecturer in the department of endocrinology at Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, said during a presentation at the AACE Annual Scientific and Clinical Congress. “In hemodialysis patients, BMD is not so useful in predicting fractures. With [trabecular bone score], things are more unclear. We don’t yet know the exact role of trabecular bone score for predicting fractures in hemodialysis patients.”

Dusceac and colleagues analyzed trabecular bone score and BMD data from 98 patients on permanent hemodialysis assessed between September and June 2018 (42.8% men; mean age, 58 years; mean time on dialysis, 5.5 years), as well as a group of 98 controls with normal kidney function, matched for sex, age and lumbar spine BMD.

Compared with controls, researchers found that patients on hemodialysis had a lower lumbar spine trabecular bone score (mean difference, 0.072; 95% CI, 0.03-0.11), lower T-score (mean difference, 0.83 standard deviation [SD], 95% CI, 0.42-1.24) and lower z score (mean difference, 0.81 SD; 95% CI, 0.41-1.2), independent of BMD levels.

Dusceac said trabecular bone score correlated with lumbar spine BMD in hemodialysis patients (r=0.382; P = .001) and controls (r=0.36; P = .002) and noted that the two regression lines had similar slopes (0.3 vs. 0.28; P = .84) with different intercepts (0.88 vs. 0.98). Additionally, adjustment for trabecular bone score increased 10-year fracture risk for patients on hemodialysis from an HR of 3.7 (95% CI, 2.4-6.1) to an HR of 5.3 (95% CI, 3.3-8.2) for major osteoporotic fracture and from an HR of 0.9 (95% CI, 0.3-2.1) to an HR of 1.5 (95% CI, 0.5-3.2) for hip fracture, Dusceac said.

“Our conclusion was that [trabecular bone score] was significantly lower for hemodialysis patients compared with controls, and this was independent of BMD value,” Dusceac said. “Lower [trabecular bone score] reflects, maybe, the changes and damage in bone mineral architecture that occurs in this kind of patient. Another interesting finding was lower BMD at the femoral neck for hemodialysis patients compared with controls, and the absolute 10-year major and hip osteoporotic fracture risk was significantly increased in hemodialysis patients.” – by Regina Schaffer

Reference:

Dusceac R, et al. Trabecular bone score is lower in patients on permanent hemodialysis compared to controls matched for bone mineral density. Presented at: AACE Annual Scientific and Clinical Congress; April 24-28, 2019; Los Angeles.

Disclosure: Dusceac reports no relevant financial disclosures.