Vascular calcification of the abdominal aorta has minimal impact on lumbar spine bone density in patients with chronic kidney disease

Jørgensen, Hanne Skou; Borghs, Herman; Heye, Sam; Smout, Dieter; Claes, Kathleen; Evenepoel, Pieter

Affiliations

¹Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium

²Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark

³Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium

⁴Department of Radiology, University Hospitals Leuven, Leuven, Belgium

⁵Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium

⁶Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium

Abstract and keywords

Background: Dual-energy X-ray absorptiometry (DXA) measurements are sensitive to artifacts from surrounding tissues. This study investigates the impact of abdominal aortic calcification (AAC) on bone mineral density (BMD) in patients with chronic kidney disease (CKD).

Methods: In 88 patients with CKD stage G5D, lumbar spine BMD was measured in both anterior-posterior (AP) and lateral DXA projections. AAC was determined from lateral lumbar radiographs.

Results: Median age was 51 ± 14 years, and 61 % were men. AAC was present in 59 %. There was no difference in lumbar spine BMD between patients with and without AAC (AP: 0.823 vs. 0.806 g/cm², p = 0.66). The ΔBMD between AP and lateral projections was similar in patients with and without AAC (13.4 ± 6.7 % vs. 11.5 ± 6.3 %; difference 1.9 %, 95 % CI −0.9 to 4.7 %, p = 0.18). When comparing single vertebrae at levels with high vs. low degree of AAC within the same individual, there was no difference in BMD (AP: 0.827 ± 0.202 vs. 0.818 ± 0.291 g/cm², p = 0.78), nor in the ΔBMD between AP and lateral projections (12.9 ± 8.1 % vs. 14.3 ± 8.3 %, p = 0.12).

Conclusion: We could not detect an impact of AAC on lumbar spine BMD. These findings challenge the dogma that lumbar spine BMD by DXA is unreliable due to widespread AAC in patients with CKD.

Keywords: Absorptiometry, photon; Bone density; Chronic kidney disease – mineral and bone disorder; Chronic renal insufficiency; Osteoporosis; Vascular calcification

Links

DOI: 10.1016/j.bone.2022.116482

PubMed: 35787485

WoS: 000826578400006

History

Received: 2022-05-4

Revised: 2022-06-28

Accepted: 2022-06-28

Online: 2022-07-1

Cited Works (2)

Year	Entry
2021	Jørgensen HS, David K, Salam S, Evenepoel P; European Renal Osteodystrophy (EUROD) workgroup, an initiative of the CKD-MBD working group of the ERA-EDTA. Traditional and non-traditional risk factors for osteoporosis in CKD. Calcif Tiss Int. April 2021;108(4):496-511.
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.

Cited By (2)

Year	Entry
2022	Abdalbary M, Elrggal ME, El-Husseini A. Does aortic calcification have really no impact on lumbar spine BMD? Bone. December 1, 2022;165:116568.
2022	Response to letter to editor regarding "Does aortic calcification have really no impact on lumbar spine BMD?" Bone. December 2022;165:116578.