Study of Trabecular Bone Score (TBS) as a Fracture Risk Factor in Chronic Renal Failure
Study of Trabecular Bone Score (TBS) as a Fracture Risk Factor in Chronic Renal Failure
Observational study
The Trabecular Bone Score (TBS) is a recent imaging tool that indirectly studies bone
 microarchitecture from 2-dimensional images of lumbar biphotonic absorptiometry (DXA). His
 interest is demonstrated in the evaluation of the fracture risk of the general population.
 The study of its interest in chronic renal failure is ongoing, only 3 studies have been
 published to our knowledge.

 Osteopathy of chronic renal failure is a complex phenomenon involving bone remodeling
 disorders, mineralization, mass and bone microarchitecture. In the renal transplant
 population, certain factors, such as anti-rejection therapy, are also involved.

 The impact of fragility fractures induced by these disorders of bone metabolism is a major
 public health issue due to the resulting morbidity and mortality, with mortality doubling in
 comparison to the general population after a hip fracture.

 The bone osteopathy assessment of chronic renal failure is the bone biopsy, however its
 realization is very limited because of its invasiveness.

 Although initially Bone Densitometry was not recommended in the evaluation of the fracture
 risk of chronic renal failure by KDIGO (Kidney Disease Improvement Global Outcomes) of 2009,
 many works published since plead in favor of its realization for the fracture risk
 assessment, in combination with the clinical data of the Fracture Risk Assessment Tool
 (FRAX), as should be recommended in the next KDIGO. Indeed, the decrease in bone density in
 chronic renal failure is associated with an increased risk of fracture.

 Clinical parameters, of course, also play an important role in the evaluation of the fracture
 risk of chronic renal insufficiency, be it the items taken into account in FRAX, certain
 factors related to chronic kidney disease, or even transplantation. kidney transplant.

 To our knowledge, only three studies on the association of TBS with fracture risk of chronic
 renal failure have been published. In particular, they show a significant association between
 the decrease in TBS and the incident fracture risk, independently of bone density and FRAX,
 in a population of kidney transplant recipients, and chronic renal insufficiency in stage 3
 or 4.

 According to KDIGO 2009, the only biomarkers recommended in the evaluation of osteopathy
 chronic renal failure are parathyroid hormone (PTH) and bone-specific alkaline phosphatase
 (BAP), although there is no established threshold for significant increase in fracture risk .
 However, there is little data on other bone remodeling markers such as the Procollagen type 1
 N-terminal propeptide (P1NP) and the C-terminal telopeptide of type 1 collagen (CTX). Some
 studies indicate, however, that they may be of interest in evaluation of osteopathy of
 chronic renal failure .
Inclusion Criteria:

 -  1st population: kidney failure patients at stage 4-5, age> 40 years, non-dialyzed,
 ungrafted.

 -  2nd population: kidney transplant patients, age> 40, first kidney transplant.

 Exclusion Criteria:

 -  Pregnant women.

 -  Incapable adults (tutelage, guardianship, safeguard of justice).

 -  Persons deprived of liberty.