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Jerban S, Moazamian D, Mohammadi HS, Ma Y, Jang H, Namiranian B, Shin SH, Alenezi S, Shah SB, Chung CB, Chang EY, Du J. More accurate trabecular bone imaging using UTE MRI at the resonance frequency of fat. Bone 2024; 184:117096. [PMID: 38631596 DOI: 10.1016/j.bone.2024.117096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
High-resolution magnetic resonance imaging (HR-MRI) has been increasingly used to assess the trabecular bone structure. High susceptibility at the marrow/bone interface may significantly reduce the marrow's apparent transverse relaxation time (T2*), overestimating trabecular bone thickness. Ultrashort echo time MRI (UTE-MRI) can minimize the signal loss caused by susceptibility-induced T2* shortening. However, UTE-MRI is sensitive to chemical shift artifacts, which manifest as spatial blurring and ringing artifacts partially due to non-Cartesian sampling. In this study, we proposed UTE-MRI at the resonance frequency of fat to minimize marrow-related chemical shift artifacts and the overestimation of trabecular thickness. Cubes of trabecular bone from six donors (75 ± 4 years old) were scanned using a 3 T clinical scanner at the resonance frequencies of fat and water, respectively, using 3D UTE sequences with five TEs (0.032, 1.1, 2.2, 3.3, and 4.4 ms) and a clinical 3D gradient echo (GRE) sequence at 0.2 × 0.2 × 0.4 mm3 voxel size. Trabecular bone thickness was measured in 30 regions of interest (ROIs) per sample. MRI results were compared with thicknesses obtained from micro-computed tomography (μCT) at 50 μm3 voxel size. Linear regression models were used to calculate the coefficient of determination between MRI- and μCT-based trabecular thickness. All MRI-based trabecular thicknesses showed significant correlations with μCT measurements. The correlations were higher (examined with paired Student's t-test, P < 0.01) for 3D UTE images performed at the fat frequency (R2 = 0.59-0.74, P < 0.01) than those at the water frequency (R2 = 0.18-0.52, P < 0.01) and clinical GRE images (R2 = 0.39-0.47, P < 0.01). Significantly reduced correlations were observed with longer TEs. This study highlighted the feasibility of UTE-MRI at the fat frequency for a more accurate assessment of trabecular bone thickness.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA.
| | - Dina Moazamian
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | | | - Yajun Ma
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Behnam Namiranian
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Soo Hyun Shin
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Salem Alenezi
- Research and Laboratories Sector, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Sameer B Shah
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA; Orthopaedic Research, University of California, San Diego, La Jolla, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA.
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Jørgensen HS, Lloret MJ, Lalayiannis AD, Shroff R, Evenepoel P. Ten tips on how to assess bone health in patients with chronic kidney disease. Clin Kidney J 2024; 17:sfae093. [PMID: 38817914 PMCID: PMC11137676 DOI: 10.1093/ckj/sfae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Indexed: 06/01/2024] Open
Abstract
Patients with chronic kidney disease (CKD) experience a several-fold increased risk of fracture. Despite the high incidence and the associated excess morbidity and premature mortality, bone fragility in CKD, or CKD-associated osteoporosis, remains a blind spot in nephrology with an immense treatment gap. Defining the bone phenotype is a prerequisite for the appropriate therapy of CKD-associated osteoporosis at the patient level. In the present review, we suggest 10 practical 'tips and tricks' for the assessment of bone health in patients with CKD. We describe the clinical, biochemical, and radiological evaluation of bone health, alongside the benefits and limitations of the available diagnostics. A bone biopsy, the gold standard for diagnosing renal bone disease, is invasive and not widely available; although useful in complex cases, we do not consider it an essential component of bone assessment in patients with CKD-associated osteoporosis. Furthermore, we advocate for the deployment of multidisciplinary expert teams at local, national, and potentially international level. Finally, we address the knowledge gaps in the diagnosis, particularly early detection, appropriate "real-time" monitoring of bone health in this highly vulnerable population, and emerging diagnostic tools, currently primarily used in research, that may be on the horizon of clinical practice.
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Affiliation(s)
- Hanne Skou Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Maria Jesús Lloret
- Department of Nephrology, Hospital Fundació Puigvert, Barcelona, Spain
- Institut de Recerca Sant-Pau (IR-Sant Pau), Barcelona, Spain
| | - Alexander D Lalayiannis
- Department of Pediatric Nephrology, Birmingham Women's and Children's Hospitals, Birmingham, UK
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Pieter Evenepoel
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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Jerban S, Jang H, Chang EY, Bukata S, Du J, Chung CB. Bone Biomarkers Based on Magnetic Resonance Imaging. Semin Musculoskelet Radiol 2024; 28:62-77. [PMID: 38330971 DOI: 10.1055/s-0043-1776431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Magnetic resonance imaging (MRI) is increasingly used to evaluate the microstructural and compositional properties of bone. MRI-based biomarkers can characterize all major compartments of bone: organic, water, fat, and mineral components. However, with a short apparent spin-spin relaxation time (T2*), bone is invisible to conventional MRI sequences that use long echo times. To address this shortcoming, ultrashort echo time MRI sequences have been developed to provide direct imaging of bone and establish a set of MRI-based biomarkers sensitive to the structural and compositional changes of bone. This review article describes the MRI-based bone biomarkers representing total water, pore water, bound water, fat fraction, macromolecular fraction in the organic matrix, and surrogates for mineral density. MRI-based morphological bone imaging techniques are also briefly described.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, La Jolla, California
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Susan Bukata
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California
| | - Jiang Du
- Department of Radiology, University of California, San Diego, La Jolla, California
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, La Jolla, California
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
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Elder GJ. Current Status of Mineral and Bone Disorders in Transplant Recipients. Transplantation 2023; 107:2107-2119. [PMID: 36788445 DOI: 10.1097/tp.0000000000004538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Most patients with end-stage kidney disease undergoing kidney transplantation are affected by the chronic kidney disease-mineral and bone disorder. This entity encompasses laboratory abnormalities, calcification of soft tissues, and the bone abnormalities of renal osteodystrophy that together result in an increased risk of fracture, cardiovascular events, and mortality. Although many biochemical disturbances associated with end-stage kidney disease improve in the first year after transplantation, hyperparathyroidism commonly persists, and residual changes of renal osteodystrophy are slow to resolve. When superimposed on common, traditional risk factors, post-transplant glucocorticoid treatment, the possibility of tubular disturbances and post-transplant chronic kidney disease, rates of incident fracture remain high. This review examines hormonal and biochemical changes before and after kidney transplantation, fracture risk assessment tools and imaging modalities, a staged approach to management and concerns associated with antiresorptive and anabolic therapies. A multidisciplinary approach is proposed as the best means to improve patient-level outcomes.
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Affiliation(s)
- Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia
- Skeletal Biology Program, Garvan Institute of Medical Research, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
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Aleksova J, Ebeling PR, Milat F, Elder GJ. DXA-derived advanced hip analysis and the trabecular bone score in end-stage kidney disease secondary to type 1 diabetes. Eur J Endocrinol 2022; 187:883-892. [PMID: 36315195 DOI: 10.1530/eje-22-0687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Patients with end-stage kidney disease (ESKD) caused by type 1 diabetes mellitus (T1DM) have a heightened fracture risk. Bone mineral density (BMD) may predict fracture less accurately in ESKD than in patients with chronic kidney disease (CKD) stages 1-3b or the general population. Alternate, readily available imaging modalities are needed to improve ESKD fracture risk assessment. This study aimed to assess dual-energy X-ray absorptiometry (DXA)-derived BMD, the trabecular bone score (TBS) and advanced hip analysis parameters in patients with ESKD due to T1DM and to compare their results with those of patients with ESKD from other causes. METHODS We compared the DXA-derived TBS, hip cortical thickness (CT) and femoral neck (FN) buckling ratio (BR), an index of FN stability, of patients with T1DM and ESKD undergoing simultaneous pancreas kidney transplantation, patients with ESKD from other causes receiving kidney transplants and population reference ranges. RESULTS Of 227 patients with ESKD, 28% had T1DM and 65% were male. Compared with other ESKD patients, patients with T1DM were younger (42 ± 7.7 vs 51 ± 13.8 years), had shorter dialysis duration (24.4 ± 21 vs 42.6 ± 40 months), had higher HbA1c (7.9 ± 1.57% vs 5.4 ± 0.95%) and had lower BMI (25 ± 6 vs 27 ± 5 kg/m2). They had lower spine, hip and UD radius BMD Z-scores (all P ≤ 0.001), TBS (1.33 ± 0.12 vs 1.36 ± 0.12; P = 0.05), CT at the FN (P = 0.03), calcar (P = 0.006) and shaft (P < 0.001) and higher BR (10.1±7.1 vs 7.7±4; P = 0.006). All ESKD parameters were lower than population-based reference ranges (P < 0.001). Adjusting for age, sex, dialysis vintage and weight, prevalent vertebral fractures in patients with T1DM and ESKD were associated with higher BR (odds ratio (OR): 3.27 (95% CI: 1.19-8.92), P = 0.002) and lower FN CT (OR: 3.70 (95% CI: 1.13-12.50)). CONCLUSION Patients with ESKD and T1DM have reduced TBS, reduced CT and increased BR compared with other ESKD patients. Prospective study of these parameters is warranted to determine their utility in fracture risk prediction and management. SIGNIFICANCE STATEMENT Patients with ESKD and T1DM have an elevated fracture risk due to decreased bone strength. As an adjunct to BMD, evaluating dual-energy X-ray absorptiometry parameters that incorporate structural change may have greater value in patients with ESKD and T1DM than in the general population. In this study, patients with ESKD due to T1DM had lower BMD, lower trabecular bone scores, more severe loss of CT and higher BR than other patients with ESKD and people from the general population. Both lower CT and higher BR were associated with prevalent vertebral fractures in patients with T1DM and ESKD. Changes to these parameters should be evaluated for incident fracture prediction.
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Affiliation(s)
- Jasna Aleksova
- Hudson Institute for Medical Research
- Department of Medicine, Monash University
- Department of Endocrinology, Monash Health
| | - Peter R Ebeling
- Department of Medicine, Monash University
- Department of Endocrinology, Monash Health
| | - Frances Milat
- Hudson Institute for Medical Research
- Department of Medicine, Monash University
- Department of Endocrinology, Monash Health
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital
- Skeletal Biology Program, Garvan Institute of Medical Research
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Nagy E, Sobh MM, Abdalbary M, Elnagar S, Elrefaey R, Shabaka S, Elshabrawy N, Shemies R, Tawfik M, Santos CGS, Barreto FC, El-Husseini A. Is Adynamic Bone Always a Disease? Lessons from Patients with Chronic Kidney Disease. J Clin Med 2022; 11:jcm11237130. [PMID: 36498703 PMCID: PMC9736225 DOI: 10.3390/jcm11237130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
Renal osteodystrophy (ROD) is a common complication of end-stage kidney disease that often starts early with loss of kidney function, and it is considered an integral part in management of patients with chronic kidney disease (CKD). Adynamic bone (ADB) is characterized by suppressed bone formation, low cellularity, and thin osteoid seams. There is accumulating evidence supporting increasing prevalence of ADB, particularly in early CKD. Contemporarily, it is not very clear whether it represents a true disease, an adaptive mechanism to prevent bone resorption, or just a transitional stage. Several co-players are incriminated in its pathogenesis, such as age, diabetes mellitus, malnutrition, uremic milieu, and iatrogenic factors. In the present review, we will discuss the up-to-date knowledge of the ADB and focus on its impact on bone health, fracture risk, vascular calcification, and long-term survival. Moreover, we will emphasize the proper preventive and management strategies of ADB that are pivotal issues in managing patients with CKD. It is still unclear whether ADB is always a pathologic condition or whether it can represent an adaptive process to suppress bone resorption and further bone loss. In this article, we tried to discuss this hard topic based on the available limited information in patients with CKD. More studies are needed to be able to clearly address this frequent ROD finding.
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Affiliation(s)
- Eman Nagy
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Mahmoud M. Sobh
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed Abdalbary
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Sherouk Elnagar
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Rabab Elrefaey
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Shimaa Shabaka
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Nehal Elshabrawy
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Rasha Shemies
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Mona Tawfik
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt
| | - Cássia Gomes S. Santos
- Department of Internal Medicine, Division of Nephrology, Federal University of Paraná, Curitiba 80060-00, PR, Brazil
| | - Fellype C. Barreto
- Department of Internal Medicine, Division of Nephrology, Federal University of Paraná, Curitiba 80060-00, PR, Brazil
| | - Amr El-Husseini
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, KY 40536-0298, USA
- Correspondence: ; Tel.: +1-859-218-0934; Fax: +1-859-323-0232
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Comparison of Diagnostic Value for Chronic Kidney Disease between 640-Slice Computed Tomography Kidney Scan and Conventional Computed Tomography Scan. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6587617. [PMID: 36082054 PMCID: PMC9433217 DOI: 10.1155/2022/6587617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the diagnostic value for chronic kidney disease (CKD) between 640-slice computed tomography (CT) kidney scan and conventional CT scan. Methods A total of 120 CKD patients who received kidney plain scan plus enhanced examination in the CT room of the Medical Imaging Department of our hospital from June 2019 to September 2019 were selected and randomly divided into the experimental group (n = 60) and the control group (n = 60). Patients in the control group received the conventional CT plain scan and enhanced scan, and for patients in the experimental group, CT plain scan was performed first, the range of 640-slice CT dynamic volume scan was determined, and after bolus injection of contrast agent, dynamic volume scan was performed for scanning in the cortical phase, myeloid phase, and secretory phase. The imaging quality and effective scanning dose were compared between the two modalities, and the relationship between CT values obtained from 640-slice CT scan and conventional CT scan and the renal impairment was analyzed. Results Compared with the control group, the image quality of 640-slice CT scan conducted in the experimental group was significantly better (P < 0.05); the effective radiation doses of the experimental group and the control group were, respectively, (1.89 ± 0.32) mSv and (3.26 ± 0.47) mSv, indicating that the dose was significantly lower in the experimental group than in the control group (t = 18.664, P < 0.001), and the correlation analysis showed that the relationship between the sum of CT values in the cortical phase of both kidneys and kidney injury in the experimental group was r = 0.835, P < 0.001. Conclusion Both 640-slice CT kidney scan and conventional CT scan can be used in the diagnosis of CKD. 640-slice CT has a lower radiation dose, better image quality, and higher application value.
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Liu J, Tang J, Xia B, Gu Z, Yin H, Zhang H, Yang H, Song B. Novel Radiomics-Clinical Model for the Noninvasive Prediction of New Fractures After Vertebral Augmentation. Acad Radiol 2022; 30:1092-1100. [PMID: 35915030 DOI: 10.1016/j.acra.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the noninvasive prediction model for new fractures after percutaneous vertebral augmentation (PVA) based on radiomics signature and clinical parameters. METHODS Data from patients who were diagnosed with osteoporotic vertebral compression fracture (OVCF) and treated with PVA in our hospital between May 2014 and April 2019 were retrospectively analyzed. Radiomics features were extracted from T1-weighted magnetic resonance imaging (MRI) of the T11-L5 segments taken before PVA. Different radiomics models was developed by using linear discriminant analysis (LDA), multilayer perceptron (MLP), and stochastic gradient descent (SGD) classifiers. A nomogram was constructed by integrating clinical parameters and Radscore that calculated by the best radiomics model. The model performance was quantified in terms of discrimination, calibration and clinical usefulness. RESULT Four clinical parameters and 16 selected radiomics features were used for model development. The clinical model showed poor discrimination capability with area under the curves (AUCs) yielding of 0.522 in the training dataset and 0.517 in the validation dataset. The LDA, MLP and SGD classifier-based radiomics model had achieved AUCs of 0.793, 0.810, and 0.797 in the training dataset, and 0.719, 0.704, and 0.725 in the validation dataset, respectively. The nomogram showed the best performance with AUCs achieving 0.810 and 0.754 in the training and validation datasets, respectively. The decision curve analysis demonstrated the net benefit of the nomogram was higher than that of other models. CONCLUSION Our findings indicate that combining clinical features with radiomics features from pre-augmentation T1-weighted MRI can be used to develop a nomogram that can predict new fractures in patients after PVA.
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Jerban S, Alenezi S, Afsahi AM, Ma Y, Du J, Chung CB, Chang E. MRI-based mechanical competence assessment of bone using micro finite element analysis (micro-FEA): Review. Magn Reson Imaging 2022; 88:9-19. [DOI: 10.1016/j.mri.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/09/2021] [Accepted: 01/20/2022] [Indexed: 12/18/2022]
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Chalmers PN, Christensen GV, Ishikawa H, Henninger HB, Kholmovski EG, Mills M, Tashjian RZ. Can magnetic resonance imaging accurately and reliably measure humeral cortical thickness? JSES Int 2021; 6:297-304. [PMID: 35252930 PMCID: PMC8888169 DOI: 10.1016/j.jseint.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Historically, imaging osseous detail in three dimensions required a computed tomography (CT) scan with ionizing radiation that poorly visualizes the soft tissues. The purpose of this study was to determine the accuracy and reliability of ultrashort echo time (UTE) magnetic resonance imaging (MRI) in measuring humeral cortical thickness and cancellous density as compared with CT. Methods This was a comparative radiographic study in nine cadavers, each of which underwent CT and UTE MRI. On images aligned to the center of the humeral shaft, anterior, posterior, medial, and lateral humeral cortical thickness was measured 5, 10, and 15 cm distal to the top of the head. Cancellous density was measured as signal within a 1-cm diameter region of interest in the center of the head, the subtuberosity head, the subarticular head, and the subarticular glenoid vault. Glenoid cortical thickness was measured at the center of the glenoid. Cortical measurements were compared using mean differences and 95% confidence intervals, paired Student’s t-tests, and intraclass correlation coefficients (ICCs). We compared cancellous measurements using Pearson’s correlation coefficients. For all measurements, we calculated interobserver and intraobserver reliability using ICCs with 0.75 as the lower limit for acceptability. Results With regard to accuracy, for humeral cortical thickness measurements, there were no significant differences between MRI and CT measures, and ICCs were >0.75. The glenoid cortical thickness ICC was <0.75. There was no significant correlation between the cancellous signal on MRI and on CT in any region. For both MRI and CT, interobserver reliability and intraobserver reliability were acceptable (ie, >0.75) for almost all humeral cortical thickness measures. Conclusion UTE MRI can reliably and accurately measure humeral cortical thickness, but cannot accurately measure cancellous density or accurately and reliably measure glenoid cortical thickness.
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Affiliation(s)
- Peter N. Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- Corresponding author: Hiroaki Ishikawa, PT, PhD, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Heath B. Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Eugene G. Kholmovski
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Megan Mills
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Robert Z. Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Ruderman I, Rajapakse CS, Xu W, Tang S, Robertson PL, Toussaint ND. Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism. Bone Rep 2021; 15:101120. [PMID: 34485631 PMCID: PMC8406147 DOI: 10.1016/j.bonr.2021.101120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA). Methods We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Results Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03). Conclusion Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness.
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Affiliation(s)
- Irene Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Winnie Xu
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Sisi Tang
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Patricia L Robertson
- Department of Radiology, The Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
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Asadipooya K, Abdalbary M, Ahmad Y, Kakani E, Monier-Faugere MC, El-Husseini A. Bone Quality in CKD Patients: Current Concepts and Future Directions - Part I. KIDNEY DISEASES (BASEL, SWITZERLAND) 2021; 7:268-277. [PMID: 34395542 PMCID: PMC8314761 DOI: 10.1159/000515534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is ample evidence that patients with CKD have an increased risk of osteoporotic fractures. Bone fragility is not only influenced by low bone volume and mass but also by poor microarchitecture and tissue quality. More emphasis has been given to the quantitative rather than qualitative assessment of bone health, both in general population and CKD patients. Although bone mineral density (BMD) is a very useful clinical tool in assessing bone strength, it may underestimate the fracture risk in CKD patients. Serum and urinary bone biomarkers have been found to be reflective of bone activities and predictive of fractures independently of BMD in CKD patients. Bone quality and fracture risk in CKD patients can be better assessed by utilizing new technologies such as trabecular bone score and high-resolution imaging studies. Additionally, invasive assessments such as bone histology and micro-indentation are useful counterparts in the evaluation of bone quality. SUMMARY A precise diagnosis of the underlying skeletal abnormalities in CKD patients is crucial to prevent further bone loss and fractures. We must consider bone quantity and quality abnormalities for management of CKD patients. Here in this part I, we are focusing on advances in bone quality diagnostics that are expected to help in proper understanding of the bone health in CKD patients. KEY MESSAGES Assessment of bone quality and quantity in CKD patients is essential. Both noninvasive and invasive techniques for the assessment of bone quality are available.
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Affiliation(s)
- Kamyar Asadipooya
- Division of Endocrinology, University of Kentucky, Lexington, Kentucky, USA
| | - Mohamed Abdalbary
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
- Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Yahya Ahmad
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Elijah Kakani
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | | | - Amr El-Husseini
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
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13
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Aleksova J, Milat F, Kotowicz MA, Pasco JA, Schultz C, Wong P, Ebeling PR, Elder GJ. Patients with end-stage kidney disease have markedly abnormal cortical hip parameters by dual-energy X-ray absorptiometry. Nephrol Dial Transplant 2021; 36:543-550. [PMID: 31697355 DOI: 10.1093/ndt/gfz195] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/01/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with end-stage kidney disease (ESKD) have higher fracture rates and post-fracture mortality than the general population, but bone mineral density by dual-energy X-ray absorptiometry (DXA) is less predictive of fracture in this patient group. Bone biopsy and high-resolution imaging indicate that cortical thickness (CT) is reduced and cortical porosity is increased in ESKD. The aim of this study was to assess cortical parameters using DXA in patients with ESKD. It was hypothesized that these parameters would show deterioration and be associated with fracture. METHODS Using advanced hip analysis, normal age-related ranges were determined from 752 female and 861 male femur scans and were compared with scans of 226 patients with ESKD at the time of transplantation. RESULTS Compared with controls, female patients had lower mean±SD CT (mms) at the femoral neck (FN) (2.59 ± 1.42 versus 5.23 ± 1.85), calcar (3.46 ± 1.07 versus 5.09 ± 1.30) and shaft (4.42 ± 1.21 versus 7.44 ± 2.07; P < 0.001 for each), and buckling ratios were higher (8.21 ± 4.6 versus 3.63 ± 1.42; P < 0.001), indicating greater FN instability. All findings were similar for men. Prevalent fracture was documented in 28.8% of patients; 12.4% vertebral only, 8.4% non-vertebral only and 8% vertebral plus non-vertebral. In adjusted models, each 1 SD reduction in FN CT and increase in the buckling ratio was associated with a respective 1.73 (1.22-2.46)- and 1.82 (1.49-2.86)-fold increase in the risk of prevalent vertebral fracture. CONCLUSIONS In patients with ESKD, DXA-derived cortical parameters are markedly abnormal compared with age- and sex-matched controls. These parameters should be assessed for incident fracture prediction and targeting treatment.
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Affiliation(s)
- Jasna Aleksova
- Hudson Institute for Medical Research, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Frances Milat
- Hudson Institute for Medical Research, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Mark A Kotowicz
- Deakin University, Geelong, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Medicine-Western Health, University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- Deakin University, Geelong, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Medicine-Western Health, University of Melbourne, St Albans, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Chris Schultz
- Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital, Adelaide, Australia
| | - Phillip Wong
- Hudson Institute for Medical Research, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Peter R Ebeling
- Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia.,Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
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14
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Soldati E, Rossi F, Vicente J, Guenoun D, Pithioux M, Iotti S, Malucelli E, Bendahan D. Survey of MRI Usefulness for the Clinical Assessment of Bone Microstructure. Int J Mol Sci 2021; 22:ijms22052509. [PMID: 33801539 PMCID: PMC7958958 DOI: 10.3390/ijms22052509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
Bone microarchitecture has been shown to provide useful information regarding the evaluation of skeleton quality with an added value to areal bone mineral density, which can be used for the diagnosis of several bone diseases. Bone mineral density estimated from dual-energy X-ray absorptiometry (DXA) has shown to be a limited tool to identify patients’ risk stratification and therapy delivery. Magnetic resonance imaging (MRI) has been proposed as another technique to assess bone quality and fracture risk by evaluating the bone structure and microarchitecture. To date, MRI is the only completely non-invasive and non-ionizing imaging modality that can assess both cortical and trabecular bone in vivo. In this review article, we reported a survey regarding the clinically relevant information MRI could provide for the assessment of the inner trabecular morphology of different bone segments. The last section will be devoted to the upcoming MRI applications (MR spectroscopy and chemical shift encoding MRI, solid state MRI and quantitative susceptibility mapping), which could provide additional biomarkers for the assessment of bone microarchitecture.
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Affiliation(s)
- Enrico Soldati
- CRMBM, CNRS, Aix Marseille University, 13385 Marseille, France;
- IUSTI, CNRS, Aix Marseille University, 13013 Marseille, France;
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
- Correspondence:
| | - Francesca Rossi
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
| | - Jerome Vicente
- IUSTI, CNRS, Aix Marseille University, 13013 Marseille, France;
| | - Daphne Guenoun
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Radiology, Institute for Locomotion, Saint-Marguerite Hospital, ISM, CNRS, APHM, Aix Marseille University, 13274 Marseille, France
| | - Martine Pithioux
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Orthopedics and Traumatology, Institute for Locomotion, Saint-Marguerite Hospital, ISM, CNRS, APHM, Aix Marseille University, 13274 Marseille, France
| | - Stefano Iotti
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
- National Institute of Biostructures and Biosystems, 00136 Rome, Italy
| | - Emil Malucelli
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
| | - David Bendahan
- CRMBM, CNRS, Aix Marseille University, 13385 Marseille, France;
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15
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Focus on the Possible Role of Dietary Sodium, Potassium, Phosphate, Magnesium, and Calcium on CKD Progression. J Clin Med 2021; 10:jcm10050958. [PMID: 33804573 PMCID: PMC7957473 DOI: 10.3390/jcm10050958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
The impressive estimated number of chronic kidney disease (CKD) patients in the world justifies any possible effort at implementing preventive measures of disease progression. Renal insufficiency is associated with significant changes in the electrolyte handling and body balance of sodium, potassium, phosphate, magnesium, and calcium, all of which are biologically vital molecules. Dietary habits could contribute significantly to the optimal management of possible derangements. In this review, we examined the available evidence recommending dietary prescriptions for these five elements aiming at reducing CKD progression. Clear evidence that specific dietary prescriptions may halt or reduce CKD progression is lacking. However, some practical recommendations are possible to prescribe the best possible therapy to the individual CKD patient.
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16
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Muscle deficits with normal bone microarchitecture and geometry in young adults with well-controlled childhood-onset Crohn's disease. Eur J Gastroenterol Hepatol 2020; 32:1497-1506. [PMID: 32675776 DOI: 10.1097/meg.0000000000001838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Muscle-bone deficits are common in pediatric Crohn's disease; however, few studies have assessed long-term musculoskeletal outcomes in adults with childhood-onset Crohn's disease. This study assessed the prevalence of musculoskeletal deficits in young adults with childhood-onset Crohn's disease compared with healthy controls. METHODS High-resolution MRI and MR spectroscopy were used to assess bone microarchitecture, cortical geometry and muscle area, and adiposity at distal femur and bone marrow adiposity (BMA) at lumbar spine. Muscle function and biomarkers of the muscle-bone unit were also assessed. RESULTS Twenty-seven adults with Crohn's disease with median (range) age 23.2 years (18.0, 36.1) and 27 age and sex-matched controls were recruited. Trabecular microarchitecture, cortical geometry and BMA were not different between Crohn's disease and controls (P > 0.05 for all). Muscle area was lower (P = 0.01) and muscle fat fraction was higher (P = 0.04) at the distal femur in Crohn's disease compared to controls. Crohn's disease participants had lower grip strength [-4.3 kg (95% confidence interval (CI), -6.8 to -1.8), P = 0.001] and relative muscle power [-5.0 W/kg (95% CI, -8.8 to -1.2), P = 0.01]. Crohn's disease activity scores negatively associated with trabecular bone volume (r = -0.40, P = 0.04) and muscle area (r = -0.41, P = 0.03). CONCLUSION Young adults with well-controlled Crohn's disease managed with contemporary therapies did not display abnormal bone microarchitecture or geometry at the distal femur but exhibited muscle deficits. The observed muscle deficits may predispose to musculoskeletal morbidity in future and interventions to improve muscle mass and function warrant investigation.
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17
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Ma YJ, Jerban S, Jang H, Chang D, Chang EY, Du J. Quantitative Ultrashort Echo Time (UTE) Magnetic Resonance Imaging of Bone: An Update. Front Endocrinol (Lausanne) 2020; 11:567417. [PMID: 33071975 PMCID: PMC7531487 DOI: 10.3389/fendo.2020.567417] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022] Open
Abstract
Bone possesses a highly complex hierarchical structure comprised of mineral (~45% by volume), organic matrix (~35%) and water (~20%). Water exists in bone in two forms: as bound water (BW), which is bound to bone mineral and organic matrix, or as pore water (PW), which resides in Haversian canals as well as in lacunae and canaliculi. Magnetic resonance (MR) imaging has been increasingly used for assessment of cortical and trabecular bone. However, bone appears as a signal void on conventional MR sequences because of its short T2*. Ultrashort echo time (UTE) sequences with echo times (TEs) 100-1,000 times shorter than those of conventional sequences allow direct imaging of BW and PW in bone. A series of quantitative UTE MRI techniques has been developed for bone evaluation. UTE and adiabatic inversion recovery prepared UTE (IR-UTE) sequences have been developed to quantify BW and PW. UTE magnetization transfer (UTE-MT) sequences have been developed to quantify collagen backbone protons, and UTE quantitative susceptibility mapping (UTE-QSM) sequences have been developed to assess bone mineral.
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Affiliation(s)
- Ya-Jun Ma
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Douglas Chang
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
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18
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Jerban S, Ma Y, Wei Z, Jang H, Chang EY, Du J. Quantitative Magnetic Resonance Imaging of Cortical and Trabecular Bone. Semin Musculoskelet Radiol 2020; 24:386-401. [PMID: 32992367 DOI: 10.1055/s-0040-1710355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bone is a composite material consisting of mineral, organic matrix, and water. Water in bone can be categorized as bound water (BW), which is bound to bone mineral and organic matrix, or as pore water (PW), which resides in Haversian canals as well as in lacunae and canaliculi. Bone is generally classified into two types: cortical bone and trabecular bone. Cortical bone is much denser than trabecular bone that is surrounded by marrow and fat. Magnetic resonance (MR) imaging has been increasingly used for noninvasive assessment of both cortical bone and trabecular bone. Bone typically appears as a signal void with conventional MR sequences because of its short T2*. Ultrashort echo time (UTE) sequences with echo times 100 to 1,000 times shorter than those of conventional sequences allow direct imaging of BW and PW in bone. This article summarizes several quantitative MR techniques recently developed for bone evaluation. Specifically, we discuss the use of UTE and adiabatic inversion recovery prepared UTE sequences to quantify BW and PW, UTE magnetization transfer sequences to quantify collagen backbone protons, UTE quantitative susceptibility mapping sequences to assess bone mineral, and conventional sequences for high-resolution imaging of PW as well as the evaluation of trabecular bone architecture.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, California
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, California
| | - Zhao Wei
- Department of Radiology, University of California, San Diego, California
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, California
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, California.,Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Jiang Du
- Department of Radiology, University of California, San Diego, California
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19
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Ruderman I, Rajapakse CS, Opperman A, Robertson PL, Masterson R, Tiong MK, Toussaint ND. Bone microarchitecture in patients undergoing parathyroidectomy for management of secondary hyperparathyroidism. Bone Rep 2020; 13:100297. [PMID: 32760761 PMCID: PMC7393533 DOI: 10.1016/j.bonr.2020.100297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) leads to complex bone disease, affecting both trabecular and cortical bone, and increased fracture risk. Optimal assessment of bone in patients with CKD is yet to be determined. High-resolution magnetic resonance imaging (MRI) can provide three-dimensional assessment of bone microarchitecture, as well as determination of mechanical strength with finite element analysis (FEA). Methods We conducted a single-centre, cross-sectional study to determine bone microarchitecture with MRI in CKD patients with SHPT undergoing parathyroidectomy. Within two weeks of surgery, MRI was performed at the distal tibia and biochemical markers of SHPT (parathyroid hormone [PTH] and alkaline phosphatase [ALP]) were collected. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Correlation of MRI findings of bone was made with biochemical markers. Results Twenty patients with CKD (15 male, 5 female) underwent MRI at the time of parathyroidectomy (16 on dialysis, 3 with functioning kidney transplant, one pre-dialysis with CKD stage 5). Median PTH at the time of surgery was 138.5 pmol/L [39.6–186.7 pmol/L]. MRI parameters in patients were consistent with trabecular deterioration, with erosion index (EI) 1.01 ± 0.3, and trabecular bone volume (BV/TV) 10.8 ± 2.9%, as well as poor trabecular network integrity with surface-to-curve ratio (S/C) 5.4 ± 2.3. There was also evidence of reduced cortical thickness, with CTh 2.698 ± 0.630 mm, and FEA demonstrated overall poor bone mechanical strength with mean elastic modulus of 2.07 ± 0.44. Conclusion Patients with severe SHPT requiring parathyroidectomy have evidence of significant changes in bone microarchitecture with trabecular deterioration, low trabecular and cortical bone volume, and reduced mechanical competence of bone.
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Affiliation(s)
- Irene Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Angelica Opperman
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Patricia L Robertson
- Department of Radiology, The Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Rosemary Masterson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Mark K Tiong
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
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20
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Aaltonen L, Koivuviita N, Seppänen M, Tong X, Kröger H, Löyttyniemi E, Metsärinne K. Correlation between 18F-Sodium Fluoride positron emission tomography and bone histomorphometry in dialysis patients. Bone 2020; 134:115267. [PMID: 32058018 DOI: 10.1016/j.bone.2020.115267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The diagnosis of renal osteodystrophy is challenging. Bone biopsy is the gold standard, but it is invasive and limited to one site of the skeleton. The ability of biomarkers to estimate the underlying bone pathology is limited. 18F-Sodium Fluoride positron emission tomography (18F-NaF PET) is a noninvasive quantitative imaging technique that allows assessment of regional bone turnover at clinically relevant sites. The hypothesis of this study was, that 18F-NaF PET correlates with bone histomorphometry in dialysis patients and could act as a noninvasive diagnostic tool in this patient group. METHODS This was a cross-sectional diagnostic test study. 26 dialysis patients with biochemical abnormalities indicating mineral and bone disorder were included. All the participants underwent a 18F-NaF PET scan and a bone biopsy. Fluoride activity in the PET scan was measured in the lumbar spine and at the anterior iliac crest. Dynamic and static histomorphometric parameters of the bone biopsy were assessed. As histomorphometric markers for bone turnover we used bone formation rate per bone surface (BFR/BS) and activation frequency per year (Ac.f). RESULTS There was a statistically significant correlation between fluoride activity in the 18F-NaF PET scan and histomorphometric parameters such as bone formation rate, activation frequency and osteoclast and osteoblast surfaces and mineralized surfaces. 18F-NaF PET's sensitivity to recognize low turnover in respect to non-low turnover was 76% and specificity 78%. Because of the small number of patients with high turnover, we were unable to demonstrate significant predictive value in this group. CONCLUSIONS A clear correlation between histomorphometric parameters and fluoride activity in the 18F-NaF PET scan was established. 18F-NaF PET may possibly be a noninvasive diagnostic tool in dialysis patients with low turnover bone disease, but further research is needed.
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Affiliation(s)
- Louise Aaltonen
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland.
| | - Niina Koivuviita
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20521, Finland
| | - Xiaoyu Tong
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland; Kuopio University Hospital, Kuopio, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, 20014 Turku, Finland
| | - Kaj Metsärinne
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland
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21
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Lalayiannis A, Crabtree N, Fewtrell M, Biassoni L, Milford D, Ferro C, Shroff R. Assessing bone mineralisation in children with chronic kidney disease: what clinical and research tools are available? Pediatr Nephrol 2020; 35:937-957. [PMID: 31240395 PMCID: PMC7184042 DOI: 10.1007/s00467-019-04271-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/11/2022]
Abstract
Mineral and bone disorder in chronic kidney disease (CKD-MBD) is a triad of biochemical imbalances of calcium, phosphate, parathyroid hormone and vitamin D, bone abnormalities and soft tissue calcification. Maintaining optimal bone health in children with CKD is important to prevent long-term complications, such as fractures, to optimise growth and possibly also to prevent extra-osseous calcification, especially vascular calcification. In this review, we discuss normal bone mineralisation, the pathophysiology of dysregulated homeostasis leading to mineralisation defects in CKD and its clinical consequences. Bone mineralisation is best assessed on bone histology and histomorphometry, but given the rarity with which this is performed, we present an overview of the tools available to clinicians to assess bone mineral density, including serum biomarkers and imaging such as dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. We discuss key studies that have used these techniques, their advantages and disadvantages in childhood CKD and their relationship to biomarkers and bone histomorphometry. Finally, we present recommendations from relevant guidelines-Kidney Disease Improving Global Outcomes and the International Society of Clinical Densitometry-on the use of imaging, biomarkers and bone biopsy in assessing bone mineral density. Given low-level evidence from most paediatric studies, bone imaging and histology remain largely research tools, and current clinical management is guided by serum calcium, phosphate, PTH, vitamin D and alkaline phosphatase levels only.
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Affiliation(s)
- A.D. Lalayiannis
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - N.J. Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - M. Fewtrell
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - L. Biassoni
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - D.V. Milford
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - C.J. Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R. Shroff
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
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22
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Damasiewicz MJ, Nickolas TL. Rethinking Bone Disease in Kidney Disease. JBMR Plus 2018; 2:309-322. [PMID: 30460334 PMCID: PMC6237213 DOI: 10.1002/jbm4.10117] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/05/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022] Open
Abstract
Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD-MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population. Furthermore, at a population level, fractures are at historically high levels in patients with end-stage kidney disease (ESKD), whereas in contrast the general population has experienced a steady decline in fracture incidence rates. Based on these findings, it is clear that a paradigm shift is needed in our approach to diagnosing and managing ROD. In clinical practice, our ability to diagnose ROD and initiate antifracture treatments is impeded by the lack of accurate noninvasive methods that identify ROD type. The past decade has seen advances in the noninvasive measurement of bone quality and strength that have been studied in kidney disease patients. Below we review the current literature pertaining to the epidemiology, pathology, diagnosis, and management of ROD. We aim to highlight the pressing need for a greater awareness of this condition and the need for the implementation of strategies that prevent fractures in kidney disease patients. Research is needed for more accurate noninvasive assessment of ROD type, clinical studies of existing osteoporosis therapies in patients across the spectrum of kidney disease, and the development of CKD-specific treatments. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Matthew J Damasiewicz
- Department of NephrologyMonash HealthClaytonAustralia
- Department of MedicineMonash UniversityClaytonAustralia
| | - Thomas L Nickolas
- Columbia University Medical CenterDepartment of MedicineDivision of NephrologyNew YorkNYUSA
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