Trabecular Bone Score in Assessing Bone Mineralization Status in Children with End- Stage Renal Disease: A Promising Tool

Areal-bone mineral density (aBMD) of lumbar-spine dual energy X-ray absorptiometry (DXA) scan is the most frequently used tool in evaluating BMD in pediatric patients, however its size dependency have significant impact on measurements accuracy in children with chronic kidney disease (CKD). This study aimed to evaluate the usefulness of trabecular bone score (TBS) computed during lumbar-spine DXA scan in assessing bone status in children on maintenance hemodialysis (HD). Ninety-three children on HD (aged 9–18 years) were subjected to lumbar-spine DXA-scan to obtain aBMD (g/cm(2)) and TBS. Z-scores of aBMD for chronological-age (aBMD(Z-CA)), height-age (aBMD(Z-HA)), and TBS(Z-score) were calculated using mean and SD values of 442 healthy controls. aBMD and TBS were significantly lower in short-for-age and normal height-for-age patients compared to the corresponding values of controls (p < 0.05 for all). Degraded vertebral microarchitecture (TBS(Z-score) < -2) was detected in 48% and 44% of male and female patients respectively. There were no significant differences in median TBS(Z-score) between short-for-age and normal height-for-age HD patients in male (p = 0.425) and in female (p = 0.316) patients. TBS(Z-score) correlated significantly with aBMD(Z-CA) (r = 0.234; p = 0.024) but not with aBMD(Z-HA) (r = 0.077; p = 0.462). Patients with history of fractures (5 patients only) had significantly lower TBS scores compared to those without fracture history (p = 0.016). Conclusion: TBS is significantly reduced in children on maintenance HD and is associated with increased fracture incidence. TBS has shown to be a promising tool in assessing bone quality (trabecular microarchitecture) in children with CKD being not size-dependent as is a-BMD, for further evaluation of its potential role in therapeutic and follow-up decisions.