Factors Associated with Low Trabecular Bone Score in Patients Receiving Maintenance Hemodialysis
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Abstract
Background: Low bone mineral density (BMD) is common among maintenance hemodialysis (MHD) patients and associated with increased fracture risk and mortality. However, BMD does not provide information on bone quality. The dual-energy X-ray absorptiometry (DXA)-derived lumbar spine trabecular bone score (TBS) facilitates the assessment of bone quality. The present study examined BMD, TBS, and factors associated with low TBS in MHD patients.
Methods: This is a single-center, cross-sectional study of 132 MHD patients. Areal BMD and lumbar spine TBS were determined by DXA. The degree of abdominal aortic calcification (AAC) was evaluated in a lateral lumbar spine radiograph using Kauppila score.
Results: The median age was 67 years and 35.3% were women. The average dialysis vintage was 4.9+5.9 years. The prevalence of osteoporosis was 39.2%. Higher prevalence of osteoporosis was observed in women (women 59.6% vs. men 27.9%). The prevalence of low TBS (<1.31) was 33.8%. TBS was also significantly lower in women (women 1.29+0.12 vs. men 1.40+0.12; P<0.001). The group of patients with low TBS showed higher percentage of female and higher serum cholesterol, alkaline phosphatase, and homocysteine compared with the group with normal TBS. Serum calcium, phosphate, magnesium, parathyroid hormone, 25-hydroxyvitamin D, and beta-2-microglobulin were comparable between the two groups. The prevalence of severe AAC (Kauppila scores ≥6) was 52.6%. There were no correlations between AAC score with BMD or TBS. In multivariate analysis, female sex was the only independent predictor of low TBS.
Conclusions: Low TBS was observed in approximately one-third of MHD patients. Female sex was the only independent predictor of low TBS. There were no correlations between mineral parameters and AAC with TBS. Whether low TBS could predict fracture risk will require further study.
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