Abstract 110: Trabecular bone score, bone mineral density nad fractures in patients of chronic kidney disease with and without diabetes mellitus

Background and Objectives: Chronic kidney disease-mineral bone disease (CKD-MBD) is a common yet neglectedlong-term complication of CKD. The primary objective of this study was to compare the proportion of patients with low trabecular bone score (TBS) in the CKD patients with diabetes mellitus (CKD-DM) andthe CKD patients without DM (CKD-NDM). The secondary objectives weretocomparebone mineral density (BMD) and morphometric vertebral fractures (VF) between the two groups. Methods: Patients ofCKD with an estimated glomerular filtration rate (eGFR)< 60 mL/min/1.73 m2 were recruited. They were classified into the CKD-DM or the CKD-NDM group based on the presence of DM. Both groups were matched for age and gender. A detailed history was taken, and a physical examination was done to rule out secondary causes of osteoporosis. Serum creatinine, electrolytes, 25-hydroxyvitamin-D [25 (OH)D], and intact parathyroid hormone (iPTH) were analysed. Areal BMD was assessed using Hologic Discovery Wi dual-energy X-ray absorptiometer. TBS was estimated from spine BMD images using TBS iNsight software v 3.1.1 (Medimaps, Geneva). A dorsolumbar spine radiograph was performed to look for morphometric VFs. Results: 316 participants with CKD (158- diabetic and 158 non-diabetic) were included. The baseline characteristics were comparable between the two groups except for a higher BMI, higher waist circumference, higher eGFR, lower magnesium, and lower 25(OH)D in the CKD-DM group. The proportion of patients with low bone turnover (iPTH levels < 80 pg/ml) was higher in the CKD-DM group (34.2% vs 27.1%). The proportion of patients with low TBS was similar between the two groups (39.86% vs 41.83%). The BMD at lumbar spine (LS) [0.977 (0.877-1.128) vs 0.945 (0.814-1.148) g/cm2] and distal forearm (FA) [0.689 (0.618-0.736) vs 0.661 (0.576-0.731) g/cm2] were also comparable between the two groups. However, BMD at femur neck (FN) [0.707 (0.624-0.798) vs 0.665 (0.586-0.768) g/cm2] and total hip (TH) [0.862 (0.760-0.951) vs 0.811 (0.713-0.916) g/cm2] were higher in the CKD-DM group. The prevalence of morphometric VF was similar between the two groups (8.5% vs 5.2%). Conclusion: In this cohort of pre-dialysis stage 3-5 CKD patients, the prevalence of low TBS, BMD at LS and distalFA was similar between the CKD-DM and the CKD-NDM groups. The BMD at FN and TH was higher in CKD with DM compared to CKD without DM.