Bone material strength index is associated with prior fracture in men with and without moderate chronic kidney disease

Holloway-Kew, Kara L.<sup>1</sup>; Rufus-Membere, Pamela<sup>1</sup>; Anderson, Kara B.<sup>1</sup>; Betson, Amelia<sup>1</sup>; Gaston, James<sup>1</sup>; Kotowicz, Mark A.<sup>1,2,3</sup>; Diez-Perez, Adolfo<sup>4</sup>; Hyde, Natalie K.<sup>1</sup>; Pasco, Julie A.<sup>1,2,3,5</sup>

Affiliations

²Barwon Health, Geelong, Australia

³Melbourne Medical School – Western Campus, Department of Medicine, The University of Melbourne, St Albans, Australia

⁴Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona, CIBERFES, Instituto Carlos III, Spain

⁵Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Abstract and keywords

Background: Patients with chronic kidney disease (CKD) are at high risk for fracture. The ability of bone mineral density (BMD) to predict fractures in CKD patients has been inconsistent. Other measures such as trabecular bone score (TBS) and impact microindentation (IMI) may be more useful in this group. This study aimed to determine if TBS or IMI values differed between men with and without CKD and examine associations between prior fracture, TBS and IMI values.

Methods: Men (n = 343, age 33–96 yr) from the Geelong Osteoporosis Study were included. Femoral neck (FNBMD) and lumbar spine BMD (LSBMD) were measured using DXA (Lunar ProdigyPro). TBS was determined from lumbar spine scans (TBS iNsight software Version 2.2). IMI values (bone material strength index; BMSi) were measured using an OsteoProbe. CKD was defined as an eGFR<60 mL/min/1.73m² (n = 53). Prior low trauma fractures (n = 37) were ascertained from radiological reports. Associations were examined using binary logistic regression, adjusting for potential confounders. Interaction terms were tested in all models.

Results: Men with CKD tended to have a higher likelihood of prior fracture (adjusted OR 2.27, 95%CI 1.02–5.01). Higher BMSi was associated with a lower likelihood of prior fracture (adjusted OR for 1SD increase: 0.70; 95%CI 0.51–0.97). This association was sustained after adjustment for FNBMD (OR 0.68; 95%CI 0.49–0.96) or LSBMD (OR 0.69; 95%CI 0.49–0.95). No interaction was detected between BMSi and CKD (p = 0.898). No associations were detected between FNBMD, LSBMD or TBS and prior fracture in either population and there were no interactions with CKD for FNBMD, LSBMD or TBS.

Conclusions: BMSi was associated with prior fracture in men with and without CKD, however, FNBMD, LSBMD and TBS were not. Lack of an interaction term suggests that BMSi performed similarly in identifying the likelihood of prior fracture, regardless of CKD status. IMI may have clinical utility for assessing fracture risk in patients with CKD.

Keywords: Impact microindentation; Trabecular bone score; Bone mineral density; Chronic kidney disease; Prior fracture; Men

Links

DOI: 10.1016/j.bone.2020.115241

PubMed: 31954850

WoS: 000517355400013

History

Received: 2019-10-3

Revised: 2020-01-15

Accepted: 2020-01-15

Online: 2020-01-16

Cited Works (5)

Year	Entry
2015	West SL, Lok CE, Langsetmo L, Cheung AM, Szabo E, Pearce D, Fusaro M, Wald R, Weinstein J, Jamal SA. Bone mineral density predicts fractures in chronic kidney disease. J Bone Miner Res. May 2015;30(5):913-919.
2013	Nickolas TL, Stein EM, Dworakowski E, Nishiyama KK, Komandah-Kosseh M, Zhang CA, McMahon DJ, Liu XS, Boutroy S, Cremers S, Shane E. Rapid cortical bone loss in patients with chronic kidney disease. J Bone Miner Res. August 2013;28(8):1811-1820.
2017	Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, Moe SM, Shroff R, Tonelli MA, Toussaint ND, Vervloet MG, Leonard MB. Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) guideline update: what’s changed and why it matters. Kidney Int. July 2017;92(1):26-36.
2014	Iki M, Tamaki J, Kadowaki E, Sato Y, Dongmei N, Winzenrieth R, Kagamimori S, Kagawa Y, Yoneshima H. Trabecular bone score (TBS) predicts vertebral fractures in Japanese women over 10 years independently of bone density and prevalent vertebral deformity: the Japanese population-based osteoporosis (JPOS) cohort study. J Bone Miner Res. February 2014;29(2):399-407.
2016	Diez-Perez A, Bouxsein M, Eriksen E, Khosla S, Nyman J, Papapoulos S, Tang S. Technical note: recommendations for a standard procedure to assess cortical bone at the tissue-level in vivo using impact microindentation. Bone Rep. December 2016;5:181-185.

Cited By (3)

Year	Entry
2021	Bover J, Ureña-Torres P, Cozzolino M, Rodríguez-García M, Gómez-Alonso C. The non-invasive diagnosis of bone disorders in CKD. Calcif Tiss Int. April 2021;108(4):512-527.
2023	Jaiswal R, Zoulakis M, Axelsson KF, Darelid A, Rudäng R, Sundh D, Litsne H, Johansson L, Lorentzon M. Increased bone material strength index is positively associated with the risk of incident osteoporotic fractures in older Swedish women. J Bone Miner Res. June 2023;38(6):860-868.
2023	Jaiswal R, Zoulakis M, Axelsson KF, Sundh D, Litsne H, Johansson L, Lorentzon M. Reply to the submitted comment regarding our publication "Increased bone material strength index is positively associated with the risk of incident osteoporotic fractures in older Swedish women". J Bone Miner Res. October 2023;38(10):1543-1544.