Pérez-Sáez María José, Prieto-Alhambra Daniel, Díez-Pérez Adolfo, Pascual Julio
Servicio de Nefrología, Hospital del Mar, Barcelona, España; Institut Mar d'Investigacions Mediques, Barcelona, España; REDinREN, Instituto Carlos III, Madrid, España.
Institut Mar d'Investigacions Mediques, Barcelona, España; Oxford NIHR Musculoskeletal Biomedical Research Unit. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. University of Oxford, Oxford, Inglaterra, Reino Unido; CIBERFES, Instituto Carlos III, Madrid, España.
Nefrologia (Engl Ed). 2018 Jan-Feb;38(1):27-33. doi: 10.1016/j.nefro.2017.04.002. Epub 2017 Nov 11.
Bone disease related to chronic kidney disease and, particularly, to kidney transplant patients is a common cause or morbidity and mortality, especially due to a higher risk of osteoporotic fractures. Despite the fact that this has been known for decades, to date, an appropriate diagnostic strategy has yet to be established. Apart from bone biopsy, which is invasive and scarcely used, no other technique is available to accurately establish the risk of fracture in kidney patients. Techniques applied to the general population, such as bone densitometry, have not been subjected to sufficient external validation and their use is not systematic. This means that the identification of patients at risk of fracture and therefore those who are candidates for preventive strategies is an unmet need. Bone strength, defined as the ability of the bone to resist fracture, is determined by bone mineral density (measured by bone densitometry), trabecular architecture and bone tissue quality. The trabecular bone score estimates bone microarchitecture, and low values have been described as an independent predictor of increased fracture risk. Bone microindentation is a minimally invasive technique that measures resistance of the bone to micro-cracks (microscopic separation of mineralised collagen fibres), and therefore bone tissue biomechanical properties. The superiority over bone densitometry of the correlation between the parameters measured by trabecular bone score and microindentation with the risk of fracture in diverse populations led us to test its feasibility in chronic kidney disease and kidney transplant patients.
与慢性肾病尤其是肾移植患者相关的骨病是发病和死亡的常见原因，特别是由于骨质疏松性骨折的风险较高。尽管这一情况已为人所知数十年，但迄今为止，尚未建立适当的诊断策略。除了具有侵入性且很少使用的骨活检外，没有其他技术可用于准确确定肾病患者的骨折风险。应用于普通人群的技术，如骨密度测定，尚未经过充分的外部验证，其使用也不系统。这意味着识别有骨折风险的患者以及因此那些适合预防策略的患者的需求尚未得到满足。骨强度定义为骨骼抵抗骨折的能力，由骨矿物质密度（通过骨密度测定测量）、小梁结构和骨组织质量决定。小梁骨评分可评估骨微结构，低值已被描述为骨折风险增加的独立预测因素。骨微压痕是一种微创技术，可测量骨骼对微裂纹（矿化胶原纤维的微观分离）的抵抗力，从而测量骨组织的生物力学特性。小梁骨评分和微压痕测量的参数与不同人群骨折风险之间的相关性优于骨密度测定，这促使我们测试其在慢性肾病和肾移植患者中的可行性。
