Diagnosis of low bone mass in CKD-5D patients

Gustav A. Blomquist, Daniel L. Davenport, Hanna W. Mawad, Marie Claude Monier-Faugere, Hartmut H. Malluche

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background and objectives: Currently, there is no consensus whether dual-energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) can be used to screen for osteoporosis or osteopenia in CKD-5D patients. This study uses iliac bone histology, the "gold standard" for bone volume evaluation, to determine the utility of DXA and QCT for low bone mass screening in CKD-5D patients. Patients and methods: A cross-sectional study of patients with CKD-5D employing iliac crest bone biopsies to assess bone volume by histology and comparing results to bone mineral density (BMD) measurements of the hip and spine by DXA and QCT. Pearson's correlation, linear regression, and receiver operating characteristics curve analyses were performed. Results: 46 patients (mean age 51 years, 52% women, median dialysis vintage 46 months) had bone biopsies, DXA, and QCT scans. 37 patients (80%) had low bone volume by histology. DXA and QCT BMD values (g/cm2) were very highly correlated at the femoral neck (ρ = 0.97) and total hip (ρ = 0.97), and to a lesser degree at the spine (ρ = 0.65). DXA and QCT t-scores were also highly correlated, but QCT t-scores were systematically greater than DXA t-scores (1.1 S.D. on average at the femoral neck) leading to less recognition of osteopenia and osteoporosis by QCT. A t-score below -1 by DXA at the femoral neck (i.e., osteopenic or osteoporotic) showed 83% sensitivity and 78% specificity relative to low bone volume by histology. A QCT t-score below -1 did not reach acceptable diagnostic levels of sensitivity and specificity. Conclusions: DXA and QCT provide nearly identical areal BMD measures at the hip. However, QCT t-scores are consistently higher than DXA t-scores resulting in less diagnosis of osteoporosis or osteopenia. DXA results showed acceptable diagnostic sensitivity and specificity for low bone volume by histology and can be used for diagnosis of osteopenia and osteoporosis in patients with CKD-5D.

Original languageEnglish
Pages (from-to)77-83
Number of pages7
JournalClinical Nephrology
Volume85
Issue number2
DOIs
StatePublished - 2016

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number R01DK080770, and the Kentucky Nephrology Research Trust. The project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000117. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We would like to thank Kimberly McLaughlin, Nedda Hughes, and Guodong Wang for their valuable technical assistance.

Publisher Copyright:
© 2016 Dustri-Verlag Dr. K. Feistle.

Keywords

  • Chronic kidney disease
  • Dialysis
  • Renal osteodystrophy

ASJC Scopus subject areas

  • Nephrology

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