Assessment of dual-energy x-ray absorptiometry measures of bone health in pediatric chronic kidney disease

Dual-energy X-ray absorptiometry (DXA) techniques are limited in childhood chronic kidney disease (CKD) by the confounding effect of short stature and opposing parathyroid hormone effects on trabecular and cortical bone. Peripheral quantitative computed tomography (pQCT) is not subject to these limitations. Lumbar spine (LS) and whole-body (WB) DXA and tibia pQCT scans were obtained in 88 stage 4-5 CKD and > 650 healthy participants, ages 5-21 years. Sex- and race-specific Z-scores were generated for bone mineral density (BMD) and bone mineral content (BMC) by DXA, relative to age and adjusted for height Z-score (LS-BMD-Z and WB-BMC-Z), and compared to pQCT Z-scores for trabecular BMD (TrabBMD-Z) for age and cortical BMC (CortBMC-Z) for age and tibia length. LS-BMD-Z [0.50 (95% C.I. 0.28, 0.73), p < 0.0001] and TrabBMD-Z [0.53 (0.27, 0.79), p < 0.0001] were greater in CKD, and WB-BMC-Z [-0.36 (-0.53, -0.19), p < 0.0001] and CortBMC-Z [-0.48 (-0.70, -0.27), p < 0.0001] were lower, compared to reference participants. Z-scores were correlated at trabecular (LS-BMD-Z and TrabBMD-Z: R = 0.36) and cortical (WB-BMC-Z and CortBMC-Z: R = 0.64) sites in CKD; similar to correlations in reference participants. Lumbar spine and whole-body DXA suggested greater trabecular BMD and lower cortical BMC in CKD, consistent with pQCT results; however, correlations were modest. Studies are needed to identify methods that predict fracture in childhood CKD.