Effect of Intravenous Contrast on Volumetric Bone Mineral Density in Patients with Chronic Kidney Disease

Volumetric bone mineral density (vBMD) can be measured from clinical computed tomography (CT) scans, facilitating screening for osteoporosis. However, use of X-ray contrast media may influence vBMD analyses, and previous studies reported as much as a 30% increase in lumbar spine (LS) vBMD after contrast administration. At the total hip (TH), an increase of only 4.1% was reported, indicating less sensitivity to contrast enhancement at this site. This study aimed to investigate the changes in vBMD after intravenous contrast media administration at both the LS and proximal femur in patients with chronic kidney disease. Seventy-one patients underwent CT angiography of the chest, abdomen, and pelvis as part of the cardiac workup before kidney transplantation. vBMD of the LS and proximal femur were calculated before and after administration of 95 mL ioversol intravenously. XY- and Bland-Altman plots and paired Student's t-test were used to evaluate changes in vBMD. After contrast media administration vBMD increased both at the LS and proximal femur. Although the absolute difference was comparable, the relative difference was almost twice as high at the LS (10.2% [6.1-14.1]) compared to the TH (5.9% [2.4-9.3], p <0.001) and femoral neck (FN) (5.3% [0.5-9.9], p <0.001). Women had a greater increase in LS-vBMD than men (13.4 ± 8.0 vs 9.8 ± 4.8 mg/cc, p = 0.02). Based on FN T-scores, 11 patients (16%) changed osteoporotic status after contrast enhancement. In conclusion vBMD of the spine and hip increased after contrast media administration in a cohort of patients with chronic kidney disease. FN T-scores from contrast-enhanced clinical CT scans should therefore be interpreted with caution. The proximal femur may be the preferred region for vBMD analysis from clinical CT scans, as sensitivity to contrast enhancement seem less at this site. These results may not be applicable to other patient populations.