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Abstract: TH-PO220

Trabecular Bone Score May Manifest as CKD-Mineral and Bone Disorder (CKD-MBD) Phenotype Reciprocal to Major Cardiovascular Outcome

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Yun, Hyojin, Ajou University School of Medicine, Suwon, Korea (the Republic of)
  • Park, Inwhee, Ajou University School of Medicine, Suwon, Korea (the Republic of)
  • Shin, Gyu Tae, Ajou University School of Medicine, Suwon, Korea (the Republic of)
  • Kim, Heungsoo, Ajou University School of Medicine, Suwon, Korea (the Republic of)
  • Jeong, Jong Cheol, Ajou University School of Medicine, Suwon, Korea (the Republic of)

In general population, trabecular bone score (TBS) represents bone microarchitecture and predicts fracture risk independent of bone mineral density (BMD). A few studies reported that TBS is significantly reduced in dialysis patients. Chronic kidney disease-mineral and bone disorder (CKD-MBD) are accompanied by increased fracture risk and cardiovascular morbidity and mortality. We investigated whether TBS is associated with comorbidity related to CKD-MBD or frailty in hemodialysis patients.


In this cross-sectional study, TBS was obtained using the TBS iNsight software program (Med-Imaps) with BMD dual energy x-ray absorptiometry (DXA) images (L1–L4) from prevalent hemodialysis patients. For frailty evaluation, Tilburg frailty indicator was used. Hand grip test and bio-impedance (InBody) were measured. Patient generated subjective global assessment (PG-SGA) was measured as nutritional assessment. History of major adverse cardiovascular event (MACE) was collected. Demographic, clinical, laboratory and biomarker data were also collected.


Total 57 patients were enrolled. Mean age of population was 56.8 ± 15.9 years old. Female was 50.9%. Diabetes mellitus (DM) was 40.4% and MACE was prevalent in 36.8 %. Mean TBS value was 1.44 ± 0.10. TBS was significantly reduced in MACE group (1.48 ± 0.10 vs. 1.38 ± 0.08, p<0.01). Multivariable regression analysis was conducted adjusting age, sex, dialysis vintage, DM, MACE, phase angle and intact parathyroid hormone. Age (ß=-0.003; p<0.01) and MACE (ß =-0.053; p=0.02) were significant predictors of TBS. α-klotho neither showed any significant difference in MACE outcome (MACE vs. no MACE, 474.0 ± 370.0 pg/mL vs. 582.8 ± 740.1 pg/mL, p=0.54), nor association with TBS (r=-0.001, p=0.41). During the period of follow up after TBS measure (about 20 months), 4 deaths, 7 new onset fractures, and 6 new onset MACEs were recorded. Lower TBS was associated with mortality (p<0.05) or new onset fracture (p<0.01, by log-rank test).


TBS was associated with age and MACE in hemodialysis patients. TBS may manifest as phenotype of frailty, also may manifest as CKD-MBD phenotype reciprocal to MACE.