Bone mineral density by DXA and HR pQCT can discriminate fracture status in men and women with stages 3 to 5 chronic kidney disease
Bone mineral density by DXA and HR pQCT can discriminate fracture status in men and women with stages 3 to 5 chronic kidney disease
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DOI：
10.1007/s00198-012-1908-y
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发表时间：
2012-12-01
影响因子：
4
通讯作者：
Lok, C. E.
中科院分区：
文献类型：
--
作者：
Jamal, S. A.;Cheung, A. M.;Lok, C. E.
骨折在慢性肾脏疾病（CKD）中很常见。我们确定通过双能x线吸收仪（DXA）和高分辨率外周定量计算机断层扫描（HR pQCT）进行骨密度测试是否可以区分CKD患者的骨折状态。这两种测试都能够区分骨折状态。此外，在DXA测量中加入HR pQCT测量并不能改善裂缝识别。鉴别CKD高骨折风险个体的最佳方法尚不清楚。我们通过DXA和HR pQCT确定骨矿物质密度（BMD）是否可以区分患有3至5期CKD的211名成年男性和女性的骨折状态，这些患者在加拿大多伦多的透析前诊所就诊。结果表示为骨折（自40岁以来普遍存在的椎体和/或低创伤）的比值比（OR）每标准差减少的预测因子，调整年龄、体重、性别和CKD分期。我们构建了接受者工作特征曲线来检验骨密度测量对骨折的判别能力。大多数参与者是白人男性，平均年龄为63.3±15.5岁。74名参与者中有77例骨折。骨密度降低与骨折风险增加相关：桡骨超远端DXA骨密度的OR = 1.56(95%可信区间（CI）， 1.41 - 1.71)， HR pQCT皮质面积的OR = 1.24 （95% CI, 1.12 - 1.36）。此外，虽然这两种测试都能够识别裂缝状态，但通过DXA将HR pQCT测量添加到BMD并不能提高裂缝识别能力。在尚未需要肾脏替代治疗的CKD患者中，DXA的BMD能够区分骨折状态。
Fractures are common in chronic kidney disease (CKD). We determined if bone mineral density testing by dual energy X-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HR pQCT) could discriminate fracture status in CKD patients. Both tests were able to discriminate fracture status. Further, the addition of HR pQCT measurements to DXA measurements did not improve fracture discrimination.The optimal method to identify individuals with CKD at high fracture risk is unknown.We determined if bone mineral density (BMD) by DXA and HR pQCT could discriminate fracture status in 211 adult men and women with stages 3 to 5 CKD, attending predialysis clinics in Toronto Canada, using logistic regression. Results are expressed as the odds ratio (OR) of fracture (prevalent vertebral and/or low trauma since age 40 years) per standard deviation decrease in the predictor adjusted for age, weight, sex, and CKD stage. We constructed receiver operating characteristic curves to examine the discriminative ability of BMD measures for fracture.Most participants were Caucasian men with a mean age of 63.3 +/- 15.5 years. There were 77 fractures in 74 participants. Decreases in BMD were associated with increased fracture risk: OR = 1.56 (95% confidence interval (CI), 1.41 to 1.71) for BMD by DXA at the ultradistal radius, and OR = 1.24 (95% CI, 1.12 to 1.36) for cortical area by HR pQCT. Further, while both tests were able to discriminate fracture status, the addition of HR pQCT measures to BMD by DXA did not improve fracture discrimination ability.Among CKD patients not yet requiring renal replacement therapy, BMD by DXA is able to discriminate fracture status.