Spine trabecular bone score as an indicator of bone microarchitecture at the peripheral skeleton in kidney transplant recipients

Matthew Luckman, Didier Hans, Natalia Cortez, Kyle K. Nishiyama, Sanchita Agarawal, Chengchen Zhang, Lucas Nikkel, Sapna Iyer, Maria Fusaro, Edward X. Guo, Donald J. McMahon, Elizabeth Shane, Thomas L. Nickolas

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Abstract

Background and objectives Studies using high-resolution peripheral quantitative computed tomography showed progressive abnormalities in cortical and trabecular microarchitecture and biomechanical competence over the first year after kidney transplantation. However, high-resolution peripheral computed tomography is a research tool lacking wide availability. In contrast, the trabecular bone score is a novel and widely available tool that uses gray-scale variograms of the spine image from dual-energy x-ray absorptiometry to assess trabecular quality. There are no studies assessing whether trabecular bone score characterizes bone quality in kidney transplant recipients. Design, settings, participants, & measurements Between 2009 and 2010, we conducted a study to assess changes in peripheral skeletal microarchitecture, measured by high-resolution peripheral computed tomography, during the first year after transplantation in 47 patients managed with early corticosteroid–withdrawal immunosuppression. All adult first-time transplant candidates were eligible. Patients underwent imaging with high-resolution peripheral computed tomography and dual-energy x-ray absorptiometry pretransplantation and 3, 6, and 12 months post-transplantation. We now test if, during the first year after transplantation, trabecular bone score assesses the evolution of bone microarchitecture and biomechanical competence as determined by high-resolution peripheral computed tomography. Results At baseline and follow-up, among the 72% and 78%, respectively, of patients having normal bone mineral density by dual-energy x-ray absorptiometry, 53% and 50%, respectively, were classified by trabecular bone score as having high fracture risk. At baseline, trabecular bone score correlated with spine, hip, and ultradistal radius bone mineral density by dual-energy x-ray absorptiometry and cortical area, density, thickness, and porosity; trabecular density, thickness, separation, and heterogeneity; and stiffness and failure load by high-resolution peripheral computed tomography. Longitudinally, each percentage increase in trabecular bone score was associated with increases in trabecular number (0.35%61.4%); decreases in trabecular thickness (20.45%60.15%), separation (20.40%60.15%), and network heterogeneity (20.48%60.20%); and increases in failure load (0.22%60.09%) by high-resolution peripheral computed tomography (all P,0.05). Conclusions Trabecular bone score may be a useful method to assess and monitor bone quality and strength and classify fracture risk in kidney transplant recipients.

Original languageEnglish (US)
Pages (from-to)644-652
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number4
DOIs
StatePublished - 2017

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Luckman, M., Hans, D., Cortez, N., Nishiyama, K. K., Agarawal, S., Zhang, C., Nikkel, L., Iyer, S., Fusaro, M., Guo, E. X., McMahon, D. J., Shane, E., & Nickolas, T. L. (2017). Spine trabecular bone score as an indicator of bone microarchitecture at the peripheral skeleton in kidney transplant recipients. Clinical Journal of the American Society of Nephrology, 12(4), 644-652. https://doi.org/10.2215/CJN.09850916