Dual-Energy X-Ray Absorptiometry-Derived Advanced Hip Analysis and the Trabecular Bone Score Are Associated With the Diagnosis of Fracture Following Kidney and Simultaneous Pancreas-Kidney Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-05-11 DOI:10.1111/ctr.70177

Tahira Scott, Jasna Aleksova, Carmel Hawley, Mina Khair, Harpreet Kaur, Christopher Schultz, Ryan Gately, Mirna Vucak-Dzumhur, James Elhindi, Grahame J. Elder

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Abstract

Background

Patients with kidney failure have elevated fracture risk that remains high following kidney transplantation. This study aimed to assess whether dual-energy x-ray absorptiometry-derived advanced hip analysis (AHA) and the trabecular bone score (TBS) improve bone mineral density (BMD)-based post-transplant fracture prediction.

Methods

Patients receiving kidney-only or simultaneous pancreas-kidney (SPK) transplants underwent immediate post-transplant dual-energy x-ray absorptiometry to provide BMD, the TBS, and AHA parameters; femoral neck, calcar, and shaft cortical thickness (CTh), and femoral neck buckling ratio (BR), an index of structural instability. Patients received treatment to reduce post-transplant BMD loss, using an established risk algorithm. Hazard ratios were determined using Kaplan–Meier and Cox proportional hazard models.

Results

Of 357 transplant recipients, 289 (83%) received a kidney-only transplant. There were 83 incident fractures over a median of 4.4 years (IQR: 2.5–5.5). Fracture was associated with type 1 diabetes mellitus (p < 0.001), former smoking (p = 0.006), lower 25-hydroxyvitamin D (p = 0.003), BMD at total proximal femur and neck of femur (p < 0.001) and spine (p = 0.008), lower CTh at the calcar (p = 0.005) and shaft (p = 0.023), higher BR (p = 0.016) and lower TBS (p = 0.047). Following multivariable adjustment, type 1 diabetes mellitus, 25-hydroxyvitamin D, smoking, and femoral neck BMD remained significant. Using the BMD-based risk algorithm, inclusion of the BR improved the model fit.

Conclusion

BMD, the TBS, and AHA parameters are associated with incident fracture in kidney-only and SPK transplant recipients. Pre-transplant smoking, lower 25-hydroxyvitamin D and BMD are potentially modifiable factors that could reduce post-transplant fracture risk.

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双能x线吸收测量衍生的高级髋关节分析和骨小梁评分与肾和胰肾联合移植后骨折的诊断相关

肾功能衰竭患者在肾移植后骨折风险升高。本研究旨在评估双能x线吸收测量法衍生的高级髋关节分析（AHA）和骨小梁评分（TBS）是否能改善基于骨矿物质密度（BMD）的移植后骨折预测。方法接受单肾或胰肾联合移植（SPK）的患者在移植后立即行双能x线吸收仪测量BMD、TBS和AHA参数；股骨颈、股骨跟和股骨轴皮质厚度（CTh），以及股骨颈屈曲率（BR），这是一种结构不稳定性指标。患者接受治疗，以减少移植后骨密度损失，使用既定的风险算法。采用Kaplan-Meier和Cox比例风险模型确定风险比。结果357例移植受者中，289例（83%）接受了纯肾移植。平均4.4年（IQR: 2.5-5.5）发生83例骨折。骨折与1型糖尿病相关(p <；0.001)、吸烟史（p = 0.006）、25-羟基维生素D水平较低（p = 0.003）、股骨近端和股骨颈骨密度(p <；0.001)、脊柱（p = 0.008）、椎弓根（p = 0.005）和脊柱（p = 0.023）、高BR （p = 0.016）和低TBS （p = 0.047）。多变量调整后，1型糖尿病、25-羟基维生素D、吸烟和股骨颈骨密度仍然显著。采用基于bmd的风险算法，加入BR可以改善模型拟合。结论BMD、TBS和AHA参数与单纯肾移植和SPK移植受者发生骨折相关。移植前吸烟、较低的25-羟基维生素D和骨密度是降低移植后骨折风险的潜在可改变因素。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.