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A multi-imaging modality study of bone density, bone structure and the muscle - bone unit in end-stage renal disease.
Bone. 2019 10; 127:271-279.BONE

Abstract

End stage renal disease (ESRD) is associated with sarcopenia and skeletal fragility. The objectives of this cross-sectional study were to (1) characterize body composition, bone mineral density (BMD) and bone structure in hemodialysis patients compared with controls, (2) assess whether DXA areal BMD (aBMD) correlates with peripheral quantitative CT (pQCT) measures of volumetric BMD (vBMD), cortical dimensions and MRI measures of trabecular microarchitecture, and (3) determine the magnitude of bone deficits in ESRD after adjustment for muscle mass. Thirty ESRD participants, ages 25 to 64 years, were compared with 403 controls for DXA and pQCT outcomes and 104 controls for MRI outcomes; results were expressed as race- and sex- specific Z-scores relative to age. DXA appendicular lean mass index (ALMI kg/m2) and total hip, femoral neck, ultradistal and 1/3rd radius aBMD were significantly lower in ESRD, vs. controls (all p < 0.01). pQCT trabecular vBMD (p < 0.01), cortical vBMD (p < 0.001) and cortical thickness (due to a greater endosteal circumference, p < 0.02) and MRI measures of trabecular number, trabecular thickness, and whole bone stiffness were lower (all p < 0.01) in ESRD, vs. controls. ALMI was positively associated with total hip, femoral neck, ultradistal radius and 1/3rd radius aBMD and with tibia cortical thickness (R = 0.46 to 0.64). Adjustment for ALMI significantly attenuated bone deficits at these sites: e.g. mean femoral neck aBMD was 0.79 SD lower in ESRD, compared with controls and this was attenuated to 0.33 with adjustment for ALMI. In multivariate models within the dialysis participants, pQCT trabecular vBMD and cortical area Z-scores were significant and independently (all p < 0.02) associated with DXA femoral neck, total hip, and ultradistal radius aBMD Z-scores. Cortical vBMD (p = 0.01) and cortical area (p < 0.001) Z-scores were significantly and independently associated with 1/3rd radius areal aBMD Z-scores (R2 = 0.62). These data demonstrate that DXA aBMD captures deficits in trabecular and cortical vBMD and cortical area. The strong associations with ALMI, as an index of skeletal muscle, highlight the importance of considering the role of sarcopenia in skeletal fragility in patients with ESRD.

Authors+Show Affiliations

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America; Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America. Electronic address: leonard5@stanford.edu.Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America.Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America.Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.Department of Medicine, Columbia University, New York, NY, United States of America.Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America.Susanne M. Glasscock School of Continuing Studies, Rice University, Houston, TX, United States of America.Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States of America.Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States of America.Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31158505

Citation

Leonard, Mary B., et al. "A Multi-imaging Modality Study of Bone Density, Bone Structure and the Muscle - Bone Unit in End-stage Renal Disease." Bone, vol. 127, 2019, pp. 271-279.
Leonard MB, Wehrli FW, Ziolkowski SL, et al. A multi-imaging modality study of bone density, bone structure and the muscle - bone unit in end-stage renal disease. Bone. 2019;127:271-279.
Leonard, M. B., Wehrli, F. W., Ziolkowski, S. L., Billig, E., Long, J., Nickolas, T. L., Magland, J. F., Nihtianova, S., Zemel, B. S., Herskovitz, R., & Rajapakse, C. S. (2019). A multi-imaging modality study of bone density, bone structure and the muscle - bone unit in end-stage renal disease. Bone, 127, 271-279. https://doi.org/10.1016/j.bone.2019.05.022
Leonard MB, et al. A Multi-imaging Modality Study of Bone Density, Bone Structure and the Muscle - Bone Unit in End-stage Renal Disease. Bone. 2019;127:271-279. PubMed PMID: 31158505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multi-imaging modality study of bone density, bone structure and the muscle - bone unit in end-stage renal disease. AU - Leonard,Mary B, AU - Wehrli,Felix W, AU - Ziolkowski,Susan L, AU - Billig,Erica, AU - Long,Jin, AU - Nickolas,Thomas L, AU - Magland,Jeremy F, AU - Nihtianova,Snejana, AU - Zemel,Babette S, AU - Herskovitz,Rita, AU - Rajapakse,Chamith S, Y1 - 2019/05/31/ PY - 2016/04/04/received PY - 2019/05/16/revised PY - 2019/05/16/accepted PY - 2019/6/4/pubmed PY - 2020/9/5/medline PY - 2019/6/4/entrez KW - Bone mineral density KW - Chronic kidney disease KW - DXA KW - MRI KW - Quantitative computed tomography KW - Sarcopenia SP - 271 EP - 279 JF - Bone JO - Bone VL - 127 N2 - End stage renal disease (ESRD) is associated with sarcopenia and skeletal fragility. The objectives of this cross-sectional study were to (1) characterize body composition, bone mineral density (BMD) and bone structure in hemodialysis patients compared with controls, (2) assess whether DXA areal BMD (aBMD) correlates with peripheral quantitative CT (pQCT) measures of volumetric BMD (vBMD), cortical dimensions and MRI measures of trabecular microarchitecture, and (3) determine the magnitude of bone deficits in ESRD after adjustment for muscle mass. Thirty ESRD participants, ages 25 to 64 years, were compared with 403 controls for DXA and pQCT outcomes and 104 controls for MRI outcomes; results were expressed as race- and sex- specific Z-scores relative to age. DXA appendicular lean mass index (ALMI kg/m2) and total hip, femoral neck, ultradistal and 1/3rd radius aBMD were significantly lower in ESRD, vs. controls (all p < 0.01). pQCT trabecular vBMD (p < 0.01), cortical vBMD (p < 0.001) and cortical thickness (due to a greater endosteal circumference, p < 0.02) and MRI measures of trabecular number, trabecular thickness, and whole bone stiffness were lower (all p < 0.01) in ESRD, vs. controls. ALMI was positively associated with total hip, femoral neck, ultradistal radius and 1/3rd radius aBMD and with tibia cortical thickness (R = 0.46 to 0.64). Adjustment for ALMI significantly attenuated bone deficits at these sites: e.g. mean femoral neck aBMD was 0.79 SD lower in ESRD, compared with controls and this was attenuated to 0.33 with adjustment for ALMI. In multivariate models within the dialysis participants, pQCT trabecular vBMD and cortical area Z-scores were significant and independently (all p < 0.02) associated with DXA femoral neck, total hip, and ultradistal radius aBMD Z-scores. Cortical vBMD (p = 0.01) and cortical area (p < 0.001) Z-scores were significantly and independently associated with 1/3rd radius areal aBMD Z-scores (R2 = 0.62). These data demonstrate that DXA aBMD captures deficits in trabecular and cortical vBMD and cortical area. The strong associations with ALMI, as an index of skeletal muscle, highlight the importance of considering the role of sarcopenia in skeletal fragility in patients with ESRD. SN - 1873-2763 UR - https://www.unboundmedicine.com/medline/citation/31158505/A_multi_imaging_modality_study_of_bone_density_bone_structure_and_the_muscle___bone_unit_in_end_stage_renal_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S8756-3282(19)30197-8 DB - PRIME DP - Unbound Medicine ER -