Abstract: SA-PO904

Bone Mineral Density by Quantitative Computed Tomography Can Predict Fractures in Kidney Transplantation Candidates

Session Information

  • Mineral Disease: CKD-Bone
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

  • 1203 Mineral Disease: CKD-Bone

Authors

  • Joergensen, Hanne Skou, Aarhus University Hospital, Aarhus, Denmark
  • Winther, Simon, Aarhus University Hospital, Aarhus, Denmark
  • Hauge, Ellen-Margrethe M., Aarhus University Hospital, Aarhus, Denmark
  • Rejnmark, Lars, Aarhus University Hospital, Aarhus, Denmark
  • Svensson, My, Akerhus University Hospital, Oslo, Norway
  • Ivarsen, Per R., Aarhus University Hospital, Aarhus, Denmark
Background

Fracture risk is increased in chronic kidney disease (CKD), but the role of bone mineral density (BMD) in assessing bone fragility is still controversial. This study investigates if BMD can predict incident fractures in late stage CKD.

Methods

Adult kidney transplantation candidates were included. Volumetric BMD of spine and hip was analyzed from computed tomography (CT) scans. Low trauma fractures were recorded from patient interviews and records.

Results

During a median follow-up of 3.7 years, 19 out of 157 patients (12%) sustained a clinical fragility fracture. Patients with fracture had reduced BMD at the hip, but not at the spine (Table 1). Type 1 diabetes (p < 0.001), bone specific alkaline phosphatase (p =0.03), and hip T- and Z-scores (p < 0.05) were identified as predictors of fracture by univariate cox regression. Thus, patients with total hip or femoral neck T-score≤-2.5 were at increased risk (Figure 1). A 1 unit decrease in total hip Z-score was associated with a 2-fold increase in the risk of fracture (HR 2.01, CI 1.24 to 3.24, p<0.01) after adjusting for dialysis therapy at baseline and kidney transplantation during follow-up.

Conclusion

Hip BMD by CT may predict fractures in adult kidney transplantation candidates with severe CKD.

Table 1 Bone density in patients with and without fracture
  Fracture (n=19)No fracture (n=136)p
Lumbar spinevBMD123±40122±390.86
 Z-score-0.54±1.30-0.43±1.380.75
 T-score-1.83±1.53-1.93±1.460.79
Total hipvBMD210±45232±440.04
 Z-score-1.82±1.12-1.15±1.070.01
 T-score-2.47±1.04-1.89±1.070.03

Data are mean±SD with p values by Student's t-test

Figure 1 Risk of incident fracture in kidney transplantation candidates, red line=total hip or femoral neck T-score≤-2.5 (n=58), green line=hip T-scores>-2.5 (n=99)

Funding

  • Private Foundation Support