Bone microarchitecture and estimated failure load are deteriorated whether patients with chronic kidney disease have normal bone mineral density, osteopenia or osteoporosis

Journal article

Ghasem-Zadeh, Ali, Bui, Minh, Seeman, Ego, Boyd, Steven K., Iuliano, Sandra, Jaipurwala, Rizwan, Mount, Peter F., Toussaint, Nigel D. and Chiang, Cherie. (2022). Bone microarchitecture and estimated failure load are deteriorated whether patients with chronic kidney disease have normal bone mineral density, osteopenia or osteoporosis. Bone. 154, p. Article 116260. https://doi.org/10.1016/j.bone.2021.116260

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Authors	Ghasem-Zadeh, Ali, Bui, Minh, Seeman, Ego, Boyd, Steven K., Iuliano, Sandra, Jaipurwala, Rizwan, Mount, Peter F., Toussaint, Nigel D. and Chiang, Cherie
Abstract	Introduction Measurement of bone mineral density (BMD) is recommended in patients with chronic kidney disease (CKD). However, most persons in the community and most patients with CKD have osteopenia, suggesting fracture risk is low. Bone loss compromises bone microarchitecture which increases fragility disproportionate to modest deficits in BMD. We therefore hypothesized that patients with CKD have reduced estimated failure load due to deterioration in microarchitecture irrespective of whether they have normal femoral neck (FN) BMD, osteopenia or osteoporosis. Methods We measured distal tibial and distal radial microarchitecture in 128 patients with CKD and 275 age- and sex-matched controls using high resolution peripheral quantitative computed tomography, FN-BMD using bone densitometry and estimated failure load at the distal appendicular sites using finite element analysis. Results Patients versus controls respectively had: lower tibial cortical area 219 (40.7) vs. 237 (35.3) mm2, p = 0.002, lower cortical volumetric BMD 543 (80.7) vs. 642 (81.7) mgHA/cm3 due to higher porosity 69.6 (6.19) vs. 61.9 (6.48)% and lower matrix mineral density 64.2 (0.62) vs. 65.1 (1.28)%, lower trabecular vBMD 92.2 (41.1) vs. 149 (43.0) mgHA/cm3 due to fewer and spatially disrupted trabeculae, lower FN-BMD 0.78 (0.12) vs. 0.94 (0.14) g/cm2 and reduced estimated failure load 3825 (1152) vs. 5778 (1467) N, all p < 0.001. Deterioration in microarchitecture and estimated failure load was most severe in patients and controls with osteoporosis. Patients with CKD with osteopenia and normal FN-BMD had more deteriorated tibial microarchitecture and estimated failure load than controls with BMD in the same category. In univariate analyses, microarchitecture and FN-BMD were both associated with estimated failure load. In multivariable analyses, only microarchitecture was independently associated with estimated failure load and accounted for 87% of the variance. Conclusions Bone fragility is likely to be present in patients with CKD despite them having osteopenia or normal BMD. Measuring microarchitecture may assist in targeting therapy to those at risk of fracture.
Keywords	bone microarchitecture; chronic kidney disease; cortical porosity; HR-pQCT; osteopenia; osteoporosis; trabecular density
Year	2022
Journal	Bone
Journal citation	154, p. Article 116260
Publisher	Elsevier Inc.
ISSN	8756-3282
Digital Object Identifier (DOI)	https://doi.org/10.1016/j.bone.2021.116260
Scopus EID	2-s2.0-85119332499
Research or scholarly	Research
Page range	1-7
Publisher's version	License All rights reserved File Access Level Controlled
Output status	Published
Online	18 Nov 2021
Publication process dates
Accepted	15 Nov 2021
Deposited	08 Mar 2022

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Perilli, Egon, Bala, Yohann, Zebaze, Roger M., Reynolds, Karen J. and Seeman, Ego. (2015). Regional heterogeneity in the configuration of the intracortical canals of the femoral shaft. Calcified Tissue International. 97(4), pp. 327 - 335. https://doi.org/10.1007/s00223-015-0014-5

Changes in quality of life associated with fragility fractures : Australian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (AusICUROS)

Abimanyi-Ochom, J., Watts, Jennifer, Borgstrom, F., Nicholson, Geoffrey, Shore-Lorenti, Catherine, Stuart, Amanda, Zhang, Y., Luliano, S., Seeman, Ego, Prince, Richard, March, Lyn, Winzenberg, T., Laslett, Laura, Duque, Gustavo, Ebeling, P. and Sanders, K. M.. (2015). Changes in quality of life associated with fragility fractures : Australian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (AusICUROS). Osteoporosis International. 26(6), pp. 1781 - 1790. https://doi.org/10.1007/s00198-015-3088-z

Genetic and environmental variances of bone microarchitecture and bone remodeling markers: A twin study

Bjornerem, Ashild, Bui, Q Minh, Wang, Xiaofang, Ghasem-Zadeh, Ali, Hopper, John L., Zebaze, Roger M. and Seeman, Ego. (2015). Genetic and environmental variances of bone microarchitecture and bone remodeling markers: A twin study. Journal of Bone and Mineral Research. 30(3), pp. 516 - 524. https://doi.org/10.1002/jbmr.2365

Bones material constituents and their contribution to bone strength in health, disease, and treatment

Bala, Y. and Seeman, Ego. (2015). Bones material constituents and their contribution to bone strength in health, disease, and treatment. Calcified Tissue International. 97(3), pp. 308 - 326. https://doi.org/10.1007/s00223-015-9971-y

A. Michael Parfitt: Enlightened scholar and revered mentor: May 10, 1930-May 18, 2015

Manolagas, Stavros C., Compston, Juliet, Rao, Sudhaker and Seeman, Ego. (2015). A. Michael Parfitt: Enlightened scholar and revered mentor: May 10, 1930-May 18, 2015. Journal of Bone and Mineral Research. 30(8), pp. 1349 - 1355. https://doi.org/10.1002/jbmr.2576

Co-administration of antiresorptive and anabolic agents: A missed opportunity

Seeman, Ego and Martin, T. John. (2015). Co-administration of antiresorptive and anabolic agents: A missed opportunity. Journal of Bone and Mineral Research. 30(5), pp. 753 - 764. https://doi.org/10.1002/jbmr.2496

The ABC of writing a grant proposal

Seeman, Ego. (2015). The ABC of writing a grant proposal. Osteoporosis International. 26(6), pp. 1665 - 1666. https://doi.org/10.1007/s00198-015-3085-2

Growth and age-related abnormalities in cortical structure and fracture risk

Seeman, Ego. (2015). Growth and age-related abnormalities in cortical structure and fracture risk. Endocrinology and Metabolism. 30(4), pp. 419 - 428. https://doi.org/10.3803/EnM.2015.30.4.419

High-resolution in vivo imaging of bone and joints: a window to microarchitecture

Geusens, P., Geusens, P., Chapurlat, Roland D., Chapurlat, Roland D., Schett, G., Ghasem-Zadeh, Ali, Ghasem-Zadeh, Ali, Seeman, Ego, De Jong, J. and Van Den Bergh, J.. (2014). High-resolution in vivo imaging of bone and joints: a window to microarchitecture. Nature Reviews Rheumatology. 10(5), pp. 304 - 313. https://doi.org/10.1038/nrrheum.2014.23

A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images

Zebaze, Roger M., Ghasem-Zadeh, Ali, Mbala, A. and Seeman, Ego. (2013). A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images. Bone. 54(1), pp. 8 - 20. https://doi.org/10.1016/j.bone.2013.01.007

Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy

Chiang, Cherie Ying, Zebaze, Roger M.D., Ghasem-Zadeh, Ali, Iuliano-Burns, Sandra, Hardidge, Andrew and Seeman, Ego. (2013). Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy. Bone. 52(1), pp. 360 - 365. https://doi.org/10.1016/j.bone.2012.10.006

Predictors of new and severe vertebral fractures: Results from the HoRIZoN Pivotal Fracture Trial

Wustrack, R., Seeman, Ego, Bucci-Rechtweg, C. and Burch, S.. (2012). Predictors of new and severe vertebral fractures: Results from the HoRIZoN Pivotal Fracture Trial. Osteoporosis International. 23(1), pp. 53 - 58. https://doi.org/10.1007/s00198-011-1664-4

The effect of acute exercise on undercarboxylated osteocalcin in obese men

Levinger, Itamar, Zebaze, Roger M., Jeru, G., Hare, David L., Selig, Steve and Seeman, Ego. (2011). The effect of acute exercise on undercarboxylated osteocalcin in obese men. Osteoporosis International. 22(5), pp. 1621 - 1626. https://doi.org/10.1007/s00198-010-1370-7