Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification
Background: KDIGO guidelines suggest the use of dual-energy X-ray absorptiometry (DXA) to assess bone mineral density (BMD) in patients with CKD 3a-5D. Previous studies have demonstrated an association between trabecular bone mass loss and coronary artery calcification (CAC) progression. This study...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Bone Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352187222000043 |
| _version_ | 1818207609459572736 |
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| author | Layon S. Campagnaro Aluizio B. Carvalho Paula M. Pina Renato Watanabe Maria Eugênia F. Canziani |
| author_facet | Layon S. Campagnaro Aluizio B. Carvalho Paula M. Pina Renato Watanabe Maria Eugênia F. Canziani |
| author_sort | Layon S. Campagnaro |
| collection | DOAJ |
| description | Background: KDIGO guidelines suggest the use of dual-energy X-ray absorptiometry (DXA) to assess bone mineral density (BMD) in patients with CKD 3a-5D. Previous studies have demonstrated an association between trabecular bone mass loss and coronary artery calcification (CAC) progression. This study aimed to prospectively investigate the relationship between BMD changes, quantified by DXA, and CAC progression in the non-dialyzed CKD population. Methods: In this post hoc study, BMD by DXA was measured at the lumbar spine and total hip at baseline and 12-months. Patients were categorized according to BMD changes into 3 different groups: LOSS, UNCHANGED and GAIN. CAC quantification was obtained by multislice computed tomography at baseline and 12-months. Results: 87 patients (55.6 ± 10.7 years, 62% males, 30% diabetic, eGFR = 39.2 ± 18.1 mL/min/1.73m2) were enrolled. CAC was found in 41 (47%) of the patients at baseline and CAC progression in 25 (64%) of them. Considering the lumbar spine and total hip BMD changes together, 24%, 48%, and 25% of the patients were in the LOSS, UNCHANGED and GAIN groups, respectively. Compared to the UNCHANGED or LOSS groups, the GAIN group had an increase in calcium score (p = 0.04) and a higher proportion of patients with CAC progression (p = 0.01). In the logistic regression analysis, CAC progression was 4.5 times more likely to be in the GAIN group. Conclusions: The association between the increase in BMD values and the progression of vascular calcification was the result of two concomitant processes overlapping, leading to a misinterpretation of DXA results. Thus, the use of DXA for the evaluation of bone mass, especially at the lumbar spine, must be applied with restraint and its results very carefully interpreted in CKD patients. |
| first_indexed | 2024-12-12T04:31:39Z |
| format | Article |
| id | doaj.art-6f8bc4eeb79640a9a150eeb26aee2869 |
| institution | Directory Open Access Journal |
| issn | 2352-1872 |
| language | English |
| last_indexed | 2024-12-12T04:31:39Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Bone Reports |
| spelling | doaj.art-6f8bc4eeb79640a9a150eeb26aee28692022-12-22T00:38:04ZengElsevierBone Reports2352-18722022-06-0116101169Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcificationLayon S. Campagnaro0Aluizio B. Carvalho1Paula M. Pina2Renato Watanabe3Maria Eugênia F. Canziani4Nephrology Division of Federal University of São Paulo, Rua Pedro de Toledo, 299 - Vila Clementino, São Paulo, SP 04039-000, BrazilNephrology Division of Federal University of São Paulo, Rua Pedro de Toledo, 299 - Vila Clementino, São Paulo, SP 04039-000, BrazilNephrology Division of Federal University of São Paulo, Rua Pedro de Toledo, 299 - Vila Clementino, São Paulo, SP 04039-000, BrazilNephrology Division of Federal University of São Paulo, Rua Pedro de Toledo, 299 - Vila Clementino, São Paulo, SP 04039-000, BrazilCorresponding author at: Rua Pedro de Toledo 299, São Paulo, SP CEP 04039-000, Brazil.; Nephrology Division of Federal University of São Paulo, Rua Pedro de Toledo, 299 - Vila Clementino, São Paulo, SP 04039-000, BrazilBackground: KDIGO guidelines suggest the use of dual-energy X-ray absorptiometry (DXA) to assess bone mineral density (BMD) in patients with CKD 3a-5D. Previous studies have demonstrated an association between trabecular bone mass loss and coronary artery calcification (CAC) progression. This study aimed to prospectively investigate the relationship between BMD changes, quantified by DXA, and CAC progression in the non-dialyzed CKD population. Methods: In this post hoc study, BMD by DXA was measured at the lumbar spine and total hip at baseline and 12-months. Patients were categorized according to BMD changes into 3 different groups: LOSS, UNCHANGED and GAIN. CAC quantification was obtained by multislice computed tomography at baseline and 12-months. Results: 87 patients (55.6 ± 10.7 years, 62% males, 30% diabetic, eGFR = 39.2 ± 18.1 mL/min/1.73m2) were enrolled. CAC was found in 41 (47%) of the patients at baseline and CAC progression in 25 (64%) of them. Considering the lumbar spine and total hip BMD changes together, 24%, 48%, and 25% of the patients were in the LOSS, UNCHANGED and GAIN groups, respectively. Compared to the UNCHANGED or LOSS groups, the GAIN group had an increase in calcium score (p = 0.04) and a higher proportion of patients with CAC progression (p = 0.01). In the logistic regression analysis, CAC progression was 4.5 times more likely to be in the GAIN group. Conclusions: The association between the increase in BMD values and the progression of vascular calcification was the result of two concomitant processes overlapping, leading to a misinterpretation of DXA results. Thus, the use of DXA for the evaluation of bone mass, especially at the lumbar spine, must be applied with restraint and its results very carefully interpreted in CKD patients.http://www.sciencedirect.com/science/article/pii/S2352187222000043Bone mineral densityDXA scanVascular calcificationCKD-BMD |
| spellingShingle | Layon S. Campagnaro Aluizio B. Carvalho Paula M. Pina Renato Watanabe Maria Eugênia F. Canziani Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification Bone Reports Bone mineral density DXA scan Vascular calcification CKD-BMD |
| title | Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification |
| title_full | Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification |
| title_fullStr | Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification |
| title_full_unstemmed | Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification |
| title_short | Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification |
| title_sort | bone mass measurement by dxa should be interpreted with caution in the ckd population with vascular calcification |
| topic | Bone mineral density DXA scan Vascular calcification CKD-BMD |
| url | http://www.sciencedirect.com/science/article/pii/S2352187222000043 |
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