Trabecular bone score and incident fragility fracture risk in adults with reduced kidney function

Kyla L. Naylor, Jerilynn Prior, Amit X. Garg, Claudie Berger, Lisa Langsetmo, Jonathan D. Adachi, David Goltzman, Christopher S. Kovacs, Robert G. Josse, William D. Leslie

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Background and objectives Trabecular bone score is a gray-level textural measure obtained from dual energy x-ray absorptiometry lumbar spine images that provides information independent of areal bonemineral density. The association between trabecular bone score and incident fractures in adultswith reduced kidney function and whether this association differs from that of adults with normal kidney function are unknown. Design, setting, participants, & measurements We included 1426 participants ages ≥40 years old (mean age of 67 years) in the community-based Canadian Multicentre Osteoporosis Study. We stratified participants at cohort entry (2005-2008) by eGFR (eGFR<60 ml/min per 1.73m2 [n=199; 72.4%stage 3a, 25.1%stage 3b, and 2.5% stage 4] versus≥60 ml/min per 1.73m2 [n=1227]). Trabecular bone scorewas obtained fromlumbar spine (L1-L4) dual energy x-ray absorptiometry images, with a lower trabecular bone score representing worse bone structure. Over an average of 4.7 years follow-up (maximum follow-up of 5 years), we documented incident fragility (low- trauma) fracture events (excluding craniofacial, foot, and hand sites). We used a modified Kaplan-Meier estimator to determine the 5-year probability of fracture. Cox proportional hazard regression per SD lower trabecular bone score expressed the gradient of fracture risk. Results Individuals with an eGFR,60 ml/min per 1.73 m2 who had a trabecular bone score value below the median (<1.277) had a significantly higher 5-year fracture probability than those above the median (18.1% versus 6.2%; P=0.01). The association between trabecular bone score and fracture was independent of bone mineral density and other clinical risk factors in adults with reduced and normal kidney function (adjusted hazard ratio per SD lower trabecular bone score: eGFR<60 ml/min per 1.73 m2: adjusted hazard ratio, 1.62; 95% confidence interval, 1.04 to 2.51; eGFR≥60 ml/min per 1.73 m2: adjusted hazard ratio, 1.44; 95% confidence interval, 1.13 to 1.83). Conclusions Lower lumbar spine trabecular bone score is independently associated with a higher fracture risk in adults with reduced kidney function. Additional study is needed to examine the association between trabecular bone score and fractures in individuals with diagnosed CKD-mineral and bone disorder.

Original languageEnglish (US)
Pages (from-to)2032-2040
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Issue number11
StatePublished - 2016

Bibliographical note

Funding Information:
We thank all of the participants in the Canadian Multicentre Osteoporosis Study (CaMos) who made this study possible and members of the CaMos research groupwho were instrumental in the ongoing success of the CaMos cohort. K.L.N. is supported by the Canadian Institutes of Health Research Fellowship and the Canadian National Transplant Research Program Astellas Training Award. A.X.G. was supported by the Dr. Adam Linton Chair in Kidney Health Analytics. This research was made possible by infrastructure support from the Lilibeth Caberto Kidney Clinical Research Unit

Publisher Copyright:
© 2016 by the American Society of Nephrology.


  • Absorptiometry, Photon
  • Bone Density
  • Bone and Bones
  • Canada
  • Confidence Intervals
  • Follow-Up Studies
  • Lumbar Vertebrae
  • Osteoporosis
  • adult
  • chronic kidney disease
  • fragility fracture
  • glomerular filtration rate
  • humans
  • minerals
  • reduced kidney function
  • risk factors
  • trabecular bone score


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