Department of Rheumatology, Lariboisière Hospital, Paris, France.
INSERM U1132, Université de Paris, Hôpital Lariboisière (APHP), Paris, France.
Am J Nephrol. 2020;51(10):833-838. doi: 10.1159/000510064. Epub 2020 Sep 10.
The incidence of skeletal fractures is high in dialysis patients. Current available tools are insufficient to predict bone fragility. We analyzed the microarchitecture in patients on dialysis therapy using bone biopsies and peripheral microcomputed tomography.
We analyzed 12 trans-iliac bone biopsies of patients with recent fractures. Bone microarchitecture was assessed in the bone cores by histology (2D-), microcomputed tomography (3D-µCT), and high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia.
Trabecular bone volume/tissue volume was similar in 2D histology and 3D-µCT (p = 0.40), while lower in HR-pQCT (p < 0.01). There was no correlation in trabecular microarchitectural indices between 2-histology and 3D-µCT, or HR-pQCT. The 3D-µCT cortical thickness (Ct.Th) were positively correlated with 2D (p < 0.05), but with HR-pQCT (p = 0.33). Ct.Th was lower in patients with ≥2 vertebral fractures than with one fracture.
3D-µCT is a reliable method for the measurement of cortical bone in bone biopsies. Prospective studies are awaited to address its value in discriminating fracture risk.
透析患者的骨骼骨折发病率很高。目前可用的工具不足以预测骨脆性。我们使用骨活检和外周微计算机断层扫描分析了透析治疗患者的微观结构。
我们分析了 12 例近期骨折的患者的髂骨活检。通过组织学（2D-）、微计算机断层扫描（3D-µCT）和胫骨高分辨率外周定量计算机断层扫描（HR-pQCT）在骨芯中评估骨微观结构。
2D 组织学和 3D-µCT 的骨小梁体积/组织体积相似（p = 0.40），而 HR-pQCT 的骨小梁体积/组织体积较低（p < 0.01）。2D 组织学和 3D-µCT 或 HR-pQCT 之间的骨小梁微观结构指数之间没有相关性。3D-µCT 皮质厚度（Ct.Th）与 2D 呈正相关（p < 0.05），但与 HR-pQCT 无相关性（p = 0.33）。皮质厚度（Ct.Th）在≥2 个椎体骨折的患者中低于一个骨折的患者。
3D-µCT 是骨活检中皮质骨测量的可靠方法。需要前瞻性研究来确定其在区分骨折风险方面的价值。
