Dataset Information

Trabecular Bone Score and Incident Fragility Fracture Risk in Adults with Reduced Kidney Function.

ABSTRACT:

Background and objectives

Trabecular bone score is a gray-level textural measure obtained from dual energy x-ray absorptiometry lumbar spine images that provides information independent of areal bone mineral density. The association between trabecular bone score and incident fractures in adults with reduced kidney function and whether this association differs from that of adults with normal kidney function are unknown.

Design, setting, participants, & measurements

We included 1426 participants ages ?40 years old (mean age of 67 years) in the community-based Canadian Multicentre Osteoporosis Study. We stratified participants at cohort entry (2005-2008) by eGFR (eGFR<60 ml/min per 1.73 m² [n=199; 72.4% stage 3a, 25.1% stage 3b, and 2.5% stage 4] versus ?60 ml/min per 1.73 m² [n=1227]). Trabecular bone score was obtained from lumbar spine (L1-L4) dual energy x-ray absorptiometry images, with a lower trabecular bone score representing worse bone structure. Over an average of 4.7 years follow-up (maximum follow-up of 5 years), we documented incident fragility (low-trauma) fracture events (excluding craniofacial, foot, and hand sites). We used a modified Kaplan-Meier estimator to determine the 5-year probability of fracture. Cox proportional hazard regression per SD lower trabecular bone score expressed the gradient of fracture risk.

Results

Individuals with an eGFR<60 ml/min per 1.73 m² who had a trabecular bone score value below the median (<1.277) had a significantly higher 5-year fracture probability than those above the median (18.1% versus 6.2%; P=0.01). The association between trabecular bone score and fracture was independent of bone mineral density and other clinical risk factors in adults with reduced and normal kidney function (adjusted hazard ratio per SD lower trabecular bone score: eGFR<60 ml/min per 1.73 m²: adjusted hazard ratio, 1.62; 95% confidence interval, 1.04 to 2.51; eGFR?60 ml/min per 1.73 m²: adjusted hazard ratio, 1.44; 95% confidence interval, 1.13 to 1.83).

Conclusions

Lower lumbar spine trabecular bone score is independently associated with a higher fracture risk in adults with reduced kidney function. Additional study is needed to examine the association between trabecular bone score and fractures in individuals with diagnosed CKD-mineral and bone disorder.

SUBMITTER: Naylor KL

PROVIDER: S-EPMC5108183 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Publications

Trabecular Bone Score and Incident Fragility Fracture Risk in Adults with Reduced Kidney Function.

Naylor Kyla L KL Prior Jerilynn J Garg Amit X AX Berger Claudie C Langsetmo Lisa L Adachi Jonathan D JD Goltzman David D Kovacs Christopher S CS Josse Robert G RG Leslie William D WD

Clinical journal of the American Society of Nephrology : CJASN 20161024 11

<h4>Background and objectives</h4>Trabecular bone score is a gray-level textural measure obtained from dual energy x-ray absorptiometry lumbar spine images that provides information independent of areal bone mineral density. The association between trabecular bone score and incident fractures in adults with reduced kidney function and whether this association differs from that of adults with normal kidney function are unknown.<h4>Design, setting, participants, & measurements</h4>We included 1426 ...[more]

PMID: 27797885

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Project description:In the large UK Biobank population-based cohort, we found that amongst men, but not women, prior fragility fracture was associated with increased risk of admission with ischaemic heart disease. INTRODUCTION:We aimed to investigate the relationship between prior fracture and risk of incident ischaemic cardiovascular events in a UK population-based cohort. METHODS:UK Biobank is a large prospective cohort comprising 502,637 men and women aged 40-69 years, with detailed baseline assessment. History of fracture was self-reported, and details of hospital admissions for ischaemic heart disease (IHD) (ICD-10:I20-I25) were obtained through linkage to UK Hospital Episode Statistics. Cox proportional hazards models were used to investigate the prospective relationships between prior fracture and hospital admission for men and women, controlling for age, BMI, smoking, alcohol, educational level, physical activity, systolic blood pressure, calcium and vitamin D use, ankle spacing-width, heel BUA and HRT use (women). RESULTS:Amongst men, a fragility fracture (hip, spine, wrist or arm fracture resulting from a simple fall) within the previous 5 years was associated with a 35% increased risk of IHD admission (fully adjusted HR 1.35; 95%CI 1.00, 1.82; p?=?0.047), with the relationship predominantly driven by wrist fractures. Associations with hospitalisation for angina in men were similar in age-adjusted models [HR1.54; 95%CI: 1.03, 2.30), p?=?0.037], but did not remain statistical significant after full adjustment [HR 1.64; 95%CI: 0.88, 3.07); p?=?0.121]. HRs for admission with angina were lower in women, and neither age- nor fully adjusted relationships attained statistical significance. CONCLUSIONS:Prior fragility fracture is an independent risk factor for incident ischaemic cardiovascular events in men. Further work may clarify whether this association is causal or represents shared risk factors, but these findings are likely to be of value in risk assessment of both osteoporosis and cardiovascular disease.

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Dataset Information

Trabecular Bone Score and Incident Fragility Fracture Risk in Adults with Reduced Kidney Function.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

Trabecular Bone Score and Incident Fragility Fracture Risk in Adults with Reduced Kidney Function.

Similar Datasets

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