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Cortical porosity not superior to conventional densitometry in identifying hemodialysis patients with fragility fracture.
PLoS One 2017; 12(2):e0171873Plos

Abstract

Hemodialysis (HD) patients face increased fracture risk, which is further associated with elevated risk of hospitalization and mortality. High-resolution peripheral computed tomography (HR-pQCT) has advanced our understanding of bone disease in chronic kidney disease by characterizing distinct changes in both the cortical and trabecular compartments. Increased cortical porosity (Ct.Po) has been shown to be associated with fracture in patients with osteopenia or in postmenopausal diabetic women. We tested whether the degree of Ct.Po identifies hemodialysis patients with prevalent fragility fractures in comparison to bone mineral density (BMD) assessed by dual X-ray absorptiometry (DXA). We performed a post-hoc analysis of a cross-sectional study in 76 prevalent hemodialysis patients. Markers of mineral metabolism, coronary calcification score, DXA-, and HR-pQCT-data were analyzed, and Ct.Po determined at radius and tibia. Ct.Po was significantly higher in patients with fracture but association was lost after adjusting for age and gender (tibia p = 0.228, radius p = 0.5). Instead, femoral (F) BMD neck area (p = 0.03), F T-score neck area (p = 0.03), radius (R) BMD (p = 0.03), R T-score (p = 0.03), and cortical HR-pQCT indices such as cortical area (Ct.Ar) (tibia: p = 0.01; radius: p = 0.02) and cortical thickness (Ct.Th) (tibia: p = 0.03; radius: p = 0.02) correctly classified patients with fragility fractures. Area under receiver operating characteristic curves (AUC) for Ct.Po (tibia AUC: 0.711; p = 0.01; radius AUC: 0.666; p = 0.04), Ct.Ar (tibia AUC: 0.832; p<0.001; radius AUC: 0.796; p<0.001), and F neck BMD (AUC: 0.758; p = 0.002) did not differ significantly among each other. In conclusion, measuring Ct.Po is not superior to BMD determined by DXA for identification of HD patients with fragility fracture.

Authors+Show Affiliations

Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.Division of General Radiology and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Vienna, Austria.Computational Imaging Research (CIR) Laboratory, Department of Biomedical Imaging and Image-Guided Therapy, Vienna, Austria. Software Competence Center Hagenberg, Hagenberg, Austria.Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.Division of General Radiology and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Vienna, Austria.Department of Medicine III, Nephrology, Transplantation, Rheumatology, Geriatrics, Ordensklinikum Linz, Linz, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28199411

Citation

Bielesz, Bernhard, et al. "Cortical Porosity Not Superior to Conventional Densitometry in Identifying Hemodialysis Patients With Fragility Fracture." PloS One, vol. 12, no. 2, 2017, pp. e0171873.
Bielesz B, Patsch JM, Fischer L, et al. Cortical porosity not superior to conventional densitometry in identifying hemodialysis patients with fragility fracture. PLoS ONE. 2017;12(2):e0171873.
Bielesz, B., Patsch, J. M., Fischer, L., Bojic, M., Winnicki, W., Weber, M., & Cejka, D. (2017). Cortical porosity not superior to conventional densitometry in identifying hemodialysis patients with fragility fracture. PloS One, 12(2), pp. e0171873. doi:10.1371/journal.pone.0171873.
Bielesz B, et al. Cortical Porosity Not Superior to Conventional Densitometry in Identifying Hemodialysis Patients With Fragility Fracture. PLoS ONE. 2017;12(2):e0171873. PubMed PMID: 28199411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cortical porosity not superior to conventional densitometry in identifying hemodialysis patients with fragility fracture. AU - Bielesz,Bernhard, AU - Patsch,Janina M, AU - Fischer,Lukas, AU - Bojic,Marija, AU - Winnicki,Wolfgang, AU - Weber,Michael, AU - Cejka,Daniel, Y1 - 2017/02/15/ PY - 2016/10/28/received PY - 2017/01/26/accepted PY - 2017/2/16/entrez PY - 2017/2/16/pubmed PY - 2017/8/29/medline SP - e0171873 EP - e0171873 JF - PloS one JO - PLoS ONE VL - 12 IS - 2 N2 - Hemodialysis (HD) patients face increased fracture risk, which is further associated with elevated risk of hospitalization and mortality. High-resolution peripheral computed tomography (HR-pQCT) has advanced our understanding of bone disease in chronic kidney disease by characterizing distinct changes in both the cortical and trabecular compartments. Increased cortical porosity (Ct.Po) has been shown to be associated with fracture in patients with osteopenia or in postmenopausal diabetic women. We tested whether the degree of Ct.Po identifies hemodialysis patients with prevalent fragility fractures in comparison to bone mineral density (BMD) assessed by dual X-ray absorptiometry (DXA). We performed a post-hoc analysis of a cross-sectional study in 76 prevalent hemodialysis patients. Markers of mineral metabolism, coronary calcification score, DXA-, and HR-pQCT-data were analyzed, and Ct.Po determined at radius and tibia. Ct.Po was significantly higher in patients with fracture but association was lost after adjusting for age and gender (tibia p = 0.228, radius p = 0.5). Instead, femoral (F) BMD neck area (p = 0.03), F T-score neck area (p = 0.03), radius (R) BMD (p = 0.03), R T-score (p = 0.03), and cortical HR-pQCT indices such as cortical area (Ct.Ar) (tibia: p = 0.01; radius: p = 0.02) and cortical thickness (Ct.Th) (tibia: p = 0.03; radius: p = 0.02) correctly classified patients with fragility fractures. Area under receiver operating characteristic curves (AUC) for Ct.Po (tibia AUC: 0.711; p = 0.01; radius AUC: 0.666; p = 0.04), Ct.Ar (tibia AUC: 0.832; p<0.001; radius AUC: 0.796; p<0.001), and F neck BMD (AUC: 0.758; p = 0.002) did not differ significantly among each other. In conclusion, measuring Ct.Po is not superior to BMD determined by DXA for identification of HD patients with fragility fracture. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/28199411/Cortical_porosity_not_superior_to_conventional_densitometry_in_identifying_hemodialysis_patients_with_fragility_fracture_ L2 - http://dx.plos.org/10.1371/journal.pone.0171873 DB - PRIME DP - Unbound Medicine ER -