Abstract
BackgroundVascular calcification progression has been associated with the loss of trabecular bone in chronic kidney disease (CKD) patients. There are few data evaluating the relationship between cortical bone loss and vascular calcification in this population. The aim of this study was to prospectively evaluate the association between changes in cortical bone density and coronary artery calcification (CAC) progression in non-dialyzed CKD patients.MethodsChanges of cortical and trabecular bone, and changes of calcium score, were analyzed using vertebral tomographic images from a prospective study. Automatic delineation of the cortical bone layer was performed by Image J software, and trabecular bone was determined by selecting a region of interest using Vitrea 2® software. Cortical and trabecular bone density (BD) were expressed in Hounsfield Units (HU), and coronary artery calcium score in Agatston Units (AU).ResultsSeventy asymptomatic patients [57.8 ± 10.2 years, 63% males, 20% diabetic, estimated glomerular filtration rate (eGFR) = 37.3 (24.8–51.3) mL/min/1.73m2] were followed for 24 months. The mean cortical and trabecular BD did not change over time. While 49 patients lost either bone, 29 (41%) patients lost cortical [− 4.4%/year (ranging from − 7.15 to − 0.5)] and 39 (56%) lost trabecular bone [− 3.15%/year (− 13.7 to − 0.25)]. There was no association between cortical and trabecular BD changes (p = 0.12). CAC was observed in 33 (46%) patients at baseline, and 30 (91%) of them showed CAC progression. While an inverse correlation between trabecular bone and calcium score changes was observed (p = 0.001), there was no correlation between cortical bone and calcium score changes (p = 0.34).ConclusionCKD patients experience either cortical or trabecular bone loss over time, but these changes do not take place simultaneously in all patients. Cortical, unlike trabecular bone loss, is not associated with vascular calcification progression in these patients.
Highlights
Vascular calcification progression has been associated with the loss of trabecular bone in chronic kidney disease (CKD) patients
Most of the knowledge on bone metabolism in chronic kidney disease (CKD) patients comes from studies performed on trabecular bone
A prospective study showed an increase of cortical porosity in hemodialysis patients, suggesting that cortical bone may contribute to the bone loss observed in this population [4]
Summary
Vascular calcification progression has been associated with the loss of trabecular bone in chronic kidney disease (CKD) patients. The aim of this study was to prospectively evaluate the association between changes in cortical bone density and coronary artery calcification (CAC) progression in non-dialyzed CKD patients. While cortical bone is a dense, low-porosity and less metabolically active tissue, trabecular bone is a honeycomb-like trabecular network with a larger remodeling area and higher turnover rate [1]. These intrinsic features go along with different key roles of each type of bone tissue, e.g., mechanical strength for cortical and mineral homeostasis for trabecular bone [2]. A prospective study showed an increase of cortical porosity in hemodialysis patients, suggesting that cortical bone may contribute to the bone loss observed in this population [4]
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