Skip to main content
Erschienen in: Osteoporosis International 4/2010

01.04.2010 | Original Article

Femoral bone mineral density reflects histologically determined cortical bone volume in hemodialysis patients

verfasst von: T. Adragao, J. Herberth, M.-C. Monier-Faugere, A. J. Branscum, A. Ferreira, J. M. Frazao, H. H. Malluche

Erschienen in: Osteoporosis International | Ausgabe 4/2010

Einloggen, um Zugang zu erhalten

Abstract

Summary

We evaluated the associations between dual energy X-ray absorptiometry (DXA) and histologically determined cancellous and cortical bone volume by controlling for vascular calcifications and demographic variables in hemodialysis (HD) patients. Femoral bone mineral density (f-BMD) was associated with cortical porosity.

Introduction

Assessment of bone mass in chronic kidney disease patients is of clinical importance because of the association between low bone volume, fractures, and vascular calcifications. DXA is used for noninvasive assessment of bone mass whereby vertebral results reflect mainly cancellous bone and femoral results reflect mainly cortical bone. Bone histology allows direct measurements of cancellous and cortical bone volume. The present study evaluates the association between DXA and histologically determined cancellous and cortical bone volumes in HD patients.

Methods

In 38 HD patients, DXA was performed for assessment of bone mass, anterior iliac crest bone biopsies for bone volume, and multislice computed tomography for vascular calcifications.

Results

While lumbar bone mineral density (l-BMD) by DXA was not associated with histologically measured cancellous bone volume, coronary Agatson score showed a borderline statistically significant association (P = 0.055). When controlled for age and dialysis duration, f-BMD by DXA was associated with cortical porosity determined by histology (P = 0.005).

Conclusions

The usefulness of l-BMD for predicting bone volume is limited most probably because of interference by soft tissue calcifications. In contrast, f-BMD shows significant association with cortical porosity.
Literatur
1.
Zurück zum Zitat Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399CrossRefPubMed Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399CrossRefPubMed
2.
Zurück zum Zitat Jadoul M, Albert JM, Akiba T, Akizawa T, Arab L, Bragg-Gresham JL, Mason N, Prutz KG, Young EW, Pisoni RL (2006) Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the dialysis outcomes and practice patterns study. Kidney Int 70:1358–1366CrossRefPubMed Jadoul M, Albert JM, Akiba T, Akizawa T, Arab L, Bragg-Gresham JL, Mason N, Prutz KG, Young EW, Pisoni RL (2006) Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the dialysis outcomes and practice patterns study. Kidney Int 70:1358–1366CrossRefPubMed
3.
Zurück zum Zitat Schulz E, Arfai K, Liu X, Sayre J, Gilsanz V (2004) Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab 89:4246–4253CrossRefPubMed Schulz E, Arfai K, Liu X, Sayre J, Gilsanz V (2004) Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab 89:4246–4253CrossRefPubMed
4.
Zurück zum Zitat Adragao T, Herberth J, Monier-Faugere MC, Branscum AJ, Ferreira A, Frazao JM, Dias Curto J, Malluche HH (2009) Low bone volume—a risk factor for coronary calcifications in hemodialysis patients. Clin J Am Soc Nephrol 4:450–455CrossRefPubMed Adragao T, Herberth J, Monier-Faugere MC, Branscum AJ, Ferreira A, Frazao JM, Dias Curto J, Malluche HH (2009) Low bone volume—a risk factor for coronary calcifications in hemodialysis patients. Clin J Am Soc Nephrol 4:450–455CrossRefPubMed
5.
Zurück zum Zitat Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36:1115–1121CrossRefPubMed Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36:1115–1121CrossRefPubMed
6.
Zurück zum Zitat Danese MD, Kim J, Doan QV, Dylan M, Griffiths R, Chertow GM (2006) PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis 47:149–156CrossRefPubMed Danese MD, Kim J, Doan QV, Dylan M, Griffiths R, Chertow GM (2006) PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis 47:149–156CrossRefPubMed
7.
Zurück zum Zitat Hans DB, Shepherd JA, Schwartz EN, Reid DM, Blake GM, Fordham JN, Fuerst T, Hadji P, Itabashi A, Krieg MA, Lewiecki EM (2008) Peripheral dual-energy X-ray absorptiometry in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom 11:188–206CrossRefPubMed Hans DB, Shepherd JA, Schwartz EN, Reid DM, Blake GM, Fordham JN, Fuerst T, Hadji P, Itabashi A, Krieg MA, Lewiecki EM (2008) Peripheral dual-energy X-ray absorptiometry in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom 11:188–206CrossRefPubMed
8.
Zurück zum Zitat Writing Group for the ISCD Position Development Conference (2004) Indications and reporting for dual-energy X-ray absorptiometry. J Clin Densitom 7:37–44CrossRef Writing Group for the ISCD Position Development Conference (2004) Indications and reporting for dual-energy X-ray absorptiometry. J Clin Densitom 7:37–44CrossRef
9.
Zurück zum Zitat Hangartner TN, Johnston CC (1990) Influence of fat on bone measurements with dual-energy absorptiometry. Bone Miner 9:71–81CrossRefPubMed Hangartner TN, Johnston CC (1990) Influence of fat on bone measurements with dual-energy absorptiometry. Bone Miner 9:71–81CrossRefPubMed
10.
Zurück zum Zitat Formica C, Loro ML, Gilsanz V, Seeman E (1995) Inhomogeneity in body fat distribution may result in inaccuracy in the measurement of vertebral bone mass. J Bone Miner Res 10:1504–1511CrossRefPubMed Formica C, Loro ML, Gilsanz V, Seeman E (1995) Inhomogeneity in body fat distribution may result in inaccuracy in the measurement of vertebral bone mass. J Bone Miner Res 10:1504–1511CrossRefPubMed
11.
Zurück zum Zitat Wren TA, Kim PS, Janicka A, Sanchez M, Gilsanz V (2007) Timing of peak bone mass: discrepancies between CT and DXA. J Clin Endocrinol Metab 92:938–941CrossRefPubMed Wren TA, Kim PS, Janicka A, Sanchez M, Gilsanz V (2007) Timing of peak bone mass: discrepancies between CT and DXA. J Clin Endocrinol Metab 92:938–941CrossRefPubMed
12.
Zurück zum Zitat Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, Teehan BP, Levey AS (2000) Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 58:353–362CrossRefPubMed Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, Teehan BP, Levey AS (2000) Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 58:353–362CrossRefPubMed
13.
Zurück zum Zitat Foley RN, Parfrey PS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32:S112–S119CrossRefPubMed Foley RN, Parfrey PS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32:S112–S119CrossRefPubMed
14.
Zurück zum Zitat Taal MW, Masud T, Green D, Cassidy MJ (1999) Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant 14:1922–1928CrossRefPubMed Taal MW, Masud T, Green D, Cassidy MJ (1999) Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant 14:1922–1928CrossRefPubMed
15.
Zurück zum Zitat Jamal SA, Chase C, Goh YI, Richardson R, Hawker GA (2002) Bone density and heel ultrasound testing do not identify patients with dialysis-dependent renal failure who have had fractures. Am J Kidney Dis 39:843–849CrossRefPubMed Jamal SA, Chase C, Goh YI, Richardson R, Hawker GA (2002) Bone density and heel ultrasound testing do not identify patients with dialysis-dependent renal failure who have had fractures. Am J Kidney Dis 39:843–849CrossRefPubMed
16.
Zurück zum Zitat Piraino B, Chen T, Cooperstein L, Segre G, Puschett J (1988) Fractures and vertebral bone mineral density in patients with renal osteodystrophy. Clin Nephrol 30:57–62PubMed Piraino B, Chen T, Cooperstein L, Segre G, Puschett J (1988) Fractures and vertebral bone mineral density in patients with renal osteodystrophy. Clin Nephrol 30:57–62PubMed
17.
Zurück zum Zitat Urena P, Bernard-Poenaru O, Ostertag A, Baudoin C, Cohen-Solal M, Cantor T, de Vernejoul MC (2003) Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 18:2325–2331CrossRefPubMed Urena P, Bernard-Poenaru O, Ostertag A, Baudoin C, Cohen-Solal M, Cantor T, de Vernejoul MC (2003) Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 18:2325–2331CrossRefPubMed
18.
Zurück zum Zitat Inaba M, Okuno S, Kumeda Y, Yamakawa T, Ishimura E, Nishizawa Y (2005) Increased incidence of vertebral fracture in older female hemodialyzed patients with type 2 diabetes mellitus. Calcif Tissue Int 76:256–260CrossRefPubMed Inaba M, Okuno S, Kumeda Y, Yamakawa T, Ishimura E, Nishizawa Y (2005) Increased incidence of vertebral fracture in older female hemodialyzed patients with type 2 diabetes mellitus. Calcif Tissue Int 76:256–260CrossRefPubMed
19.
Zurück zum Zitat Lindergard B, Johnell O, Nilsson BE, Wiklund PE (1985) Studies of bone morphology, bone densitometry and laboratory data in patients on maintenance hemodialysis treatment. Nephron 39:122–129CrossRefPubMed Lindergard B, Johnell O, Nilsson BE, Wiklund PE (1985) Studies of bone morphology, bone densitometry and laboratory data in patients on maintenance hemodialysis treatment. Nephron 39:122–129CrossRefPubMed
20.
Zurück zum Zitat Van Eps CL, Jeffries JK, Anderson JA, Bergin PT, Johnson DW, Campbell SB, Carpenter SM, Isbel NM, Mudge DW, Hawley CM (2007) Mineral metabolism, bone histomorphometry and vascular calcification in alternate night nocturnal haemodialysis. Nephrology (Carlton) 12:224–233CrossRef Van Eps CL, Jeffries JK, Anderson JA, Bergin PT, Johnson DW, Campbell SB, Carpenter SM, Isbel NM, Mudge DW, Hawley CM (2007) Mineral metabolism, bone histomorphometry and vascular calcification in alternate night nocturnal haemodialysis. Nephrology (Carlton) 12:224–233CrossRef
21.
Zurück zum Zitat Goldner J (1938) A modification of the Masson trichrome technique for routine laboratory purposes. Am J Pathol 14:237–243PubMed Goldner J (1938) A modification of the Masson trichrome technique for routine laboratory purposes. Am J Pathol 14:237–243PubMed
22.
Zurück zum Zitat Lillie PD, Fullmer HM (1976) Histopathologic technique and practical histochemistry. McGraw Hill, New York Lillie PD, Fullmer HM (1976) Histopathologic technique and practical histochemistry. McGraw Hill, New York
23.
Zurück zum Zitat Denton J, Freemont AJ, Ball J (1984) Detection of distribution of aluminum in bone. J Clin Pathol 37:136–142CrossRefPubMed Denton J, Freemont AJ, Ball J (1984) Detection of distribution of aluminum in bone. J Clin Pathol 37:136–142CrossRefPubMed
24.
Zurück zum Zitat Gomori G (1936) Microtechnical demonstration: a criticism of its methods. Am J Pathol 12:655–663PubMed Gomori G (1936) Microtechnical demonstration: a criticism of its methods. Am J Pathol 12:655–663PubMed
25.
Zurück zum Zitat Malluche HH, Meyer W, Sherman D, Massry SG (1982) Quantitative bone histology in 84 normal American subjects. Micromorphometric analysis and evaluation of variance in iliac bone. Calcif Tissue Int 34:449–455CrossRefPubMed Malluche HH, Meyer W, Sherman D, Massry SG (1982) Quantitative bone histology in 84 normal American subjects. Micromorphometric analysis and evaluation of variance in iliac bone. Calcif Tissue Int 34:449–455CrossRefPubMed
26.
Zurück zum Zitat Malluche HH, Faugere MC (1986) Atlas of mineralized bone histology. Karger, New York Malluche HH, Faugere MC (1986) Atlas of mineralized bone histology. Karger, New York
27.
Zurück zum Zitat Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRef Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRef
28.
Zurück zum Zitat NIH Consensus Development Panel (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795CrossRef NIH Consensus Development Panel (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795CrossRef
29.
Zurück zum Zitat Miller PD, Bonnick SL, Rosen CJ (1996) Consensus of an international panel on the clinical utility of bone mass measurements in the detection of low bone mass in the adult population. Calcif Tissue Int 58:207–214PubMed Miller PD, Bonnick SL, Rosen CJ (1996) Consensus of an international panel on the clinical utility of bone mass measurements in the detection of low bone mass in the adult population. Calcif Tissue Int 58:207–214PubMed
30.
Zurück zum Zitat Lindberg JS, Moe SM (1999) Osteoporosis in end-state renal disease. Semin Nephrol 19:115–122PubMed Lindberg JS, Moe SM (1999) Osteoporosis in end-state renal disease. Semin Nephrol 19:115–122PubMed
31.
Zurück zum Zitat Hruska KA, Teitelbaum SL (1995) Renal osteodystrophy. N Engl J Med 33:166–174CrossRef Hruska KA, Teitelbaum SL (1995) Renal osteodystrophy. N Engl J Med 33:166–174CrossRef
32.
Zurück zum Zitat Cunningham J, Sprague SM, Cannata-Andia J, Coco M, Cohen-Solal M, Fitzpatrick L, Goltzmann D, Lafage-Proust MH, Leonard M, Ott S, Rodriguez M, Stehman-Breen C, Stern P, Weisinger J (2004) Osteoporosis in chronic kidney disease. Am J Kidney Dis 43:566–571CrossRefPubMed Cunningham J, Sprague SM, Cannata-Andia J, Coco M, Cohen-Solal M, Fitzpatrick L, Goltzmann D, Lafage-Proust MH, Leonard M, Ott S, Rodriguez M, Stehman-Breen C, Stern P, Weisinger J (2004) Osteoporosis in chronic kidney disease. Am J Kidney Dis 43:566–571CrossRefPubMed
33.
Zurück zum Zitat Miller PD (2005) Treatment of osteoporosis in chronic kidney disease and end-stage renal disease. Curr Osteoporos Rep 3:5–12CrossRefPubMed Miller PD (2005) Treatment of osteoporosis in chronic kidney disease and end-stage renal disease. Curr Osteoporos Rep 3:5–12CrossRefPubMed
34.
Zurück zum Zitat Lobao R, Carvalho AB, Cuppari L, Ventura R, Lazaretti-Castro M, Jorgetti V, Vieira JG, Cendoroglo M, Draibe SA (2004) High prevalence of low bone mineral density in pre-dialysis chronic kidney disease patients: bone histomorphometric analysis. Clin Nephrol 62:432–439PubMed Lobao R, Carvalho AB, Cuppari L, Ventura R, Lazaretti-Castro M, Jorgetti V, Vieira JG, Cendoroglo M, Draibe SA (2004) High prevalence of low bone mineral density in pre-dialysis chronic kidney disease patients: bone histomorphometric analysis. Clin Nephrol 62:432–439PubMed
35.
Zurück zum Zitat Dorr LD, Arnala I, Faugere MC, Malluche HH (1990) Five-year postoperative results of cemented femoral arthroplasty in patients with systemic bone disease. Clin Orthop Relat Res 259:114–121PubMed Dorr LD, Arnala I, Faugere MC, Malluche HH (1990) Five-year postoperative results of cemented femoral arthroplasty in patients with systemic bone disease. Clin Orthop Relat Res 259:114–121PubMed
36.
Zurück zum Zitat Boyce TM, Bloebaum RD (1993) Cortical aging differences and fracture implications for the human femoral neck. Bone 14:769–778CrossRefPubMed Boyce TM, Bloebaum RD (1993) Cortical aging differences and fracture implications for the human femoral neck. Bone 14:769–778CrossRefPubMed
37.
Zurück zum Zitat Bell KL, Loveridge N, Power J, Garrahan N, Meggitt BF, Reeve J (1999) Regional differences in cortical porosity in the fractured femoral neck. Bone 24:57–64CrossRefPubMed Bell KL, Loveridge N, Power J, Garrahan N, Meggitt BF, Reeve J (1999) Regional differences in cortical porosity in the fractured femoral neck. Bone 24:57–64CrossRefPubMed
38.
Zurück zum Zitat Mayhew PM, Thomas CD, Clement JG, Loveridge N, Beck TJ, Bonfield W, Burgoyne CJ, Reeve J (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135CrossRefPubMed Mayhew PM, Thomas CD, Clement JG, Loveridge N, Beck TJ, Bonfield W, Burgoyne CJ, Reeve J (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135CrossRefPubMed
39.
Zurück zum Zitat Ersoy FF, Passadakis SP, Tam P, Memmos ED, Katopodis PK, Ozener C, Akcicek F, Camsari T, Ates K, Ataman R, Vlachojannis JG, Dombros AN, Utas C, Akpolat T, Bozfakioglu S, Wu G, Karayaylali I, Arinsoy T, Stathakis PC, Yavuz M, Tsakiris JD, Dimitriades CA, Yilmaz ME, Gultekin M, Karayalcin B, Yardimsever M, Oreopoulos DG (2006) Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients. J Bone Miner Metab 24:79–86CrossRefPubMed Ersoy FF, Passadakis SP, Tam P, Memmos ED, Katopodis PK, Ozener C, Akcicek F, Camsari T, Ates K, Ataman R, Vlachojannis JG, Dombros AN, Utas C, Akpolat T, Bozfakioglu S, Wu G, Karayaylali I, Arinsoy T, Stathakis PC, Yavuz M, Tsakiris JD, Dimitriades CA, Yilmaz ME, Gultekin M, Karayalcin B, Yardimsever M, Oreopoulos DG (2006) Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients. J Bone Miner Metab 24:79–86CrossRefPubMed
Metadaten
Titel
Femoral bone mineral density reflects histologically determined cortical bone volume in hemodialysis patients
verfasst von
T. Adragao
J. Herberth
M.-C. Monier-Faugere
A. J. Branscum
A. Ferreira
J. M. Frazao
H. H. Malluche
Publikationsdatum
01.04.2010
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 4/2010
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-009-0988-9

Weitere Artikel der Ausgabe 4/2010

Osteoporosis International 4/2010 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.