Bone microarchitecture and estimated bone strength in patients after kidney transplantation

Kidney disease is a serious disease that affects around 2 million Canadians. In addition to the loss of kidney function, patients with kidney disease have an increased risk of bone fracture. This risk is even higher after kidney transplant. The resulting fractures are extremely debilitating, reduce an individual's quality of life, and cost the health care system a significant amount of money to treat. This research project uses a new medical imaging technology (high-resolution peripheral quantitative computed tomography; HR-pQCT) that provides detailed images of bone structure in patients. This tool is a significant improvement over the tools currently used (dual x-ray absorptiometry; DXA) because it measures bone density and three-dimensional structure. Using this new technology and computer models, we can analyze a patient's bones and provide individualized estimates of his/her bone strength. Because of the limitations of the current tools, there have been conflicting reports regarding the effects that kidney disease has on the skeleton. Using this exciting new 3D technology, we will be able to gain a better understanding of what is actually happening in the bones of kidney transplant patients and put health care professionals in a better position to identify and manage those at risk of fracture. We will be working with groups of patients who have undergone a kidney transplant and given varying regimens of corticosteroids to prevent transplant rejection. We will apply this new technology to analyze changes in bone density and structure. Finally, we will use computer models to estimate the bone strength. This research will provide important insight into the bone quality of patients with kidney disease and their fracture risk. Even a small reduction in the number of bone fractures due to kidney disease and kidney transplant will have a major impact on both the quality of life of those Canadians suffering from the disease and the associated health care costs.