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Aortic vascular calcification is inversely associated with the trabecular bone score in patients receiving dialysis


INTRODUCTION: Progressive chronic kidney disease (CKD) confers a marked increase in risk for vascular calcification, cardiovascular disease, fracture and mortality, with likely contributing factors including dysregulated bone metabolism and mineral homeostasis. In general population studies, increased vascular calcification is directly related to mortality and inversely related to bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). In patients with CKD, abnormalities in turnover, mineralization and bone volume reduce the ability of DXA to predict fracture. The trabecular bone score (TBS) obtained from lumbar spine DXA images, provides a surrogate measure of microarchitectural integrity not captured by BMD. This study aimed to examine the association of the TBS to prevalent abdominal aortic calcification (AAC) in patients with CKD receiving dialysis. METHODS: We performed a cross-sectional study of dialysis patients awaiting transplantation. All patients underwent laboratory testing, lateral spinal radiographs including the abdominal aorta, DXA imaging and TBS assessment. AAC scores were determined using the Kauppila method. Correlations and linear regression models were used to determine predictors of AAC scores. RESULTS: 146 patients (60% male, mean age 48+/-13years) were included, of whom 49% had prevalent calcification with an AAC score>/=1. Of those with calcification, the mean AAC score was 7+/-5.5 and 42 patients had scores>/=6, considered to indicate severe AAC. TBS values corresponding to intermediate or high risk for fracture (<1.31) were present in 35% of patients. TBS values correlated inversely to AAC scores (beta=-0.206, p=0.013) and remained significant in multivariable linear regression, adjusting for age, BMI and time on dialysis (-0.160, p=0.031). There was no significant correlation of AAC scores to any BMD parameter. CONCLUSION: There is a high prevalence of AAC in relatively young dialysis patients awaiting transplantation and their AAC scores are inversely related to the TBS but not to DXA-derived BMD parameters. In patients with CKD on dialysis, TBS assessment reflects microarchitectural abnormalities of bone not captured by DXA. The inverse relationship of TBS to vascular calcification may provide insights into bone-vascular interactions in CKD.

Type Journal
ISBN 1873-2763 (Electronic) 1873-2763 (Linking)
Authors Aleksova, J.; Kurniawan, S.; Vucak-Dzumhur, M.; Kerr, P.; Ebeling, P. R.; Milat, F.; Elder, G. J.
Responsible Garvan Author Prof Grahame Elder
Publisher Name BONE
Published Date 2018-05-29
Published Volume 113
Published Pages 118-123
Status Published in-print
DOI 10.1016/j.bone.2018.05.014
URL link to publisher's version