Abstract：
BACKGROUND: The impairment of bone microarchitecture is a key determinant of skeletal fragility in patients with chronic kidney disease (CKD). The trabecular bone score (TBS) has been developed as a reliable noninvasive index of bone quality. However, its utility in this setting is still debated.
OBJECTIVE: The aim of this systematic review and meta-analysis was to summarize the available evidence about TBS as a marker of skeletal fragility across the spectrum of CKD.
METHODS: PubMed/Medline, EMBASE, and Cochrane Library databases were systematically searched until July 2023 for studies reporting data about TBS in patients with CKD. Effect sizes were pooled through a random-effect model.
RESULTS: Compared to controls, lower TBS values were observed in CKD patients not on dialysis (-0.057, 95%CI:[-0.090, -0.024], P < .01), in dialysis patients (-0.106, 95%CI:[-0.141, -0.070], P < .01), and in kidney transplant recipients (KTRs) (-0.058, 95%CI:[-0.103, -0.012], P = .01). With respect to fracture risk, TBS was able to predict incident fractures in nondialysis patients at unadjusted analyses (hazard ratio [HR] per SD decrease: 1.45, 95%CI:[1.05, 2.00], P = .02), though only a nonsignificant trend was maintained when fully adjusting the model for FRAX® (HR = 1.26, 95%CI:[0.88, 1.80], P = .21). Dialysis patients with prevalent fractures had lower TBS values compared to unfractured ones (-0.070, 95% CI:[-0.111, -0.028], P < .01). Some studies supported a correlation between TBS and fracture risk in KTRs, but results could not be pooled due to the lack of sufficient data.
CONCLUSIONS: CKD patients are characterized by an impairment of bone microarchitecture, as demonstrated by lower TBS values, across the whole spectrum of kidney disease. TBS can also be helpful in the discrimination of fracture risk, with lower values being correlated with a higher risk of prevalent and incident fractures.
OBJECTIVE: The aim of this systematic review and meta-analysis was to summarize the available evidence about TBS as a marker of skeletal fragility across the spectrum of CKD.
METHODS: PubMed/Medline, EMBASE, and Cochrane Library databases were systematically searched until July 2023 for studies reporting data about TBS in patients with CKD. Effect sizes were pooled through a random-effect model.
RESULTS: Compared to controls, lower TBS values were observed in CKD patients not on dialysis (-0.057, 95%CI:[-0.090, -0.024], P < .01), in dialysis patients (-0.106, 95%CI:[-0.141, -0.070], P < .01), and in kidney transplant recipients (KTRs) (-0.058, 95%CI:[-0.103, -0.012], P = .01). With respect to fracture risk, TBS was able to predict incident fractures in nondialysis patients at unadjusted analyses (hazard ratio [HR] per SD decrease: 1.45, 95%CI:[1.05, 2.00], P = .02), though only a nonsignificant trend was maintained when fully adjusting the model for FRAX® (HR = 1.26, 95%CI:[0.88, 1.80], P = .21). Dialysis patients with prevalent fractures had lower TBS values compared to unfractured ones (-0.070, 95% CI:[-0.111, -0.028], P < .01). Some studies supported a correlation between TBS and fracture risk in KTRs, but results could not be pooled due to the lack of sufficient data.
CONCLUSIONS: CKD patients are characterized by an impairment of bone microarchitecture, as demonstrated by lower TBS values, across the whole spectrum of kidney disease. TBS can also be helpful in the discrimination of fracture risk, with lower values being correlated with a higher risk of prevalent and incident fractures.
摘要：
背景：骨微结构受损是慢性肾脏病（CKD）患者骨骼脆性的关键决定因素。骨小梁评分（TBS）已被开发为可靠的非侵入性骨质量指标。然而,它在这个设置中的效用仍然存在争议。
目的：本系统综述和荟萃分析的目的是总结关于TBS作为CKD中骨骼脆性标志的现有证据。
方法：PubMed/Medline，直到2023年7月，系统搜索EMBASE和CochraneLibrary数据库，以获取报告CKD患者TBS数据的研究。通过随机效应模型汇集效应大小。
结果：与对照组相比，在未接受透析的CKD患者中观察到较低的TBS值（-0.057，95CI：[-0.090，-0.024]，p<0.01),透析患者（-0.106，95CI：[-0.141，-0.070]，p<0.01）和肾移植受者（KTRs）（-0.058，95CI：[-0.103，-0.012]，p=0.01)。关于骨折风险，TBS能够在未经调整的分析中预测非透析患者的意外骨折（每标准差下降的风险比（HR）：1.45,95CI：[1.05,2.00]，p=0.02),尽管在完全调整FRAX®模型时只保持了不显著的趋势(HR=1.26,95CI：[0.88,1.80]，p=0.21）。与未骨折的透析患者相比，普遍存在骨折的透析患者的TBS值较低（-0.070，95％CI：[-0.111，-0.028]，p<0.01)。一些研究支持TBS与KTRs骨折风险之间的相关性，但由于缺乏足够的数据,结果无法汇总.
结论：CKD患者的特征是骨微结构受损，正如较低的TBS值所证明的那样，涵盖整个肾脏疾病。TBS还可以帮助识别骨折风险，较低的值与较高的普遍和意外骨折风险相关。
目的：本系统综述和荟萃分析的目的是总结关于TBS作为CKD中骨骼脆性标志的现有证据。
方法：PubMed/Medline，直到2023年7月，系统搜索EMBASE和CochraneLibrary数据库，以获取报告CKD患者TBS数据的研究。通过随机效应模型汇集效应大小。
结果：与对照组相比，在未接受透析的CKD患者中观察到较低的TBS值（-0.057，95CI：[-0.090，-0.024]，p<0.01),透析患者（-0.106，95CI：[-0.141，-0.070]，p<0.01）和肾移植受者（KTRs）（-0.058，95CI：[-0.103，-0.012]，p=0.01)。关于骨折风险，TBS能够在未经调整的分析中预测非透析患者的意外骨折（每标准差下降的风险比（HR）：1.45,95CI：[1.05,2.00]，p=0.02),尽管在完全调整FRAX®模型时只保持了不显著的趋势(HR=1.26,95CI：[0.88,1.80]，p=0.21）。与未骨折的透析患者相比，普遍存在骨折的透析患者的TBS值较低（-0.070，95％CI：[-0.111，-0.028]，p<0.01)。一些研究支持TBS与KTRs骨折风险之间的相关性，但由于缺乏足够的数据,结果无法汇总.
结论：CKD患者的特征是骨微结构受损，正如较低的TBS值所证明的那样，涵盖整个肾脏疾病。TBS还可以帮助识别骨折风险，较低的值与较高的普遍和意外骨折风险相关。
