Women's College Research Institute, 790 Bay Street, Suite 725, Toronto, ON, M5G 1N8, Canada.
Osteoporos Int. 2012 Dec;23(12):2805-13. doi: 10.1007/s00198-012-1908-y.
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.
我们旨在确定双能 X 射线吸收法（DXA）和高分辨率外周定量计算机断层扫描（HR pQCT）的骨矿物质密度（BMD）检测是否可以区分慢性肾脏病（CKD）患者的骨折状态。
我们使用逻辑回归，在加拿大多伦多的透析前诊所，确定 211 名处于 3 至 5 期 CKD 的成年男性和女性中，DXA 和 HR pQCT 能否区分骨折状态。结果表示为在调整年龄、体重、性别和 CKD 分期后，每个预测因子标准偏差降低时骨折的比值比（OR）。我们构建了受试者工作特征曲线来检查 BMD 测量对骨折的区分能力。
大多数参与者为白种人男性，平均年龄为 63.3±15.5 岁。74 名参与者中有 77 例骨折。BMD 降低与骨折风险增加相关：DXA 检测的超远端桡骨 BMD 的 OR=1.56（95%置信区间（CI），1.41 至 1.71），HR pQCT 检测的皮质面积的 OR=1.24（95%CI，1.12 至 1.36）。此外，虽然这两种检测都能区分骨折状态，但将 HR pQCT 测量值添加到 DXA 的 BMD 中并没有提高骨折的区分能力。
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。
