Comparing Bone Microarchitecture by Trabecular Bone Score (TBS) in Caucasian American Women with and Without Osteoporotic Fractures

AbstractChronic glucocorticoid therapy is associated with osteoporosis and can cause fractures in up to 50% of patients. Increased risk of fractures in patients with glucocorticoid-induced osteoporosis does not result only from the decreased bone mineral density (BMD) but also bone microarchitecture deterioration. Trabecular bone score (TBS) is a method complementary to DXA, providing additional information about trabecular bone structure. The aim of this study was to assess the clinical utility of TBS in fracture risk assessment of patients treated with glucocorticoids. Patients with rheumatic diseases treated with glucocorticoids for at least 3 months were enrolled. All recruited patients underwent DXA with additional TBS assessment. We analyzed the frequency of osteoporosis and osteoporotic fractures and assessed factors that might be associated with the risk of osteoporotic fractures. A total of 64 patients were enrolled. TBS and TBS T-score values were significantly lower in patients with osteoporosis compared to patients without osteoporosis. Low energy fractures occurred in 19 patients. The disturbed bone microarchitecture was found in 30% of patients with fractures without osteoporosis diagnosis based on BMD. In the multivariate analysis, only TBS and age were significantly associated with the occurrence of osteoporotic fractures. TBS reflects the influence of glucocorticoid therapy on bone quality better than DXA measured BMD and provides an added value to DXA in identifying the group of patients particularly prone to fractures.

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TBS (Trabecular Bone Score) and Diabetes-Related Fracture Risk

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2012-3118 ◽

2013 ◽

Vol 98 (2) ◽

pp. 602-609 ◽

Cited By ~ 206

Author(s):

William D. Leslie ◽

Berengère Aubry-Rozier ◽

Olivier Lamy ◽

Didier Hans ◽

Keyword(s):

Lumbar Spine ◽

Fracture Risk ◽

Trabecular Bone ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Osteoporotic Fractures ◽

Hazard Ratio ◽

Mineral Density ◽

Major Osteoporotic Fractures ◽

Lower Lumbar Spine

Abstract Context: Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD. Objective: This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes. Design and Setting: We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada. Patients: We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes. Main Outcome Measures: Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years). Results: Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30–2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10–1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24–1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements. Conclusions: Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.

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Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing’s Syndrome

Frontiers in Endocrinology ◽

10.3389/fendo.2020.593173 ◽

2021 ◽

Vol 11 ◽

Author(s):

Barbara Stachowska ◽

Jowita Halupczok-Żyła ◽

Justyna Kuliczkowska-Płaksej ◽

Joanna Syrycka ◽

Marek Bolanowski

Keyword(s):

Lumbar Spine ◽

Fracture Risk ◽

Trabecular Bone ◽

Cushing’S Syndrome ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Osteoporotic Fractures ◽

Cushing's Syndrome ◽

Mineral Density ◽

Anthropometric Parameters

IntroductionThe impairment in bone microarchitecture and reduced bone quality are relevant mechanisms underlying the increased fracture risk in Cushing’s syndrome (CS). The trabecular bone score (TBS) is a relatively novel textural index of bone microarchitecture.PurposeThe objective of the study was to compare TBS, bone mineral density (BMD), and fracture risk in patients with endogenous CS to controls. We have investigated the association of TBS with anthropometric parameters and 25(OH) vitamin D concentrations.Materials and MethodsThe study group comprised 19 consecutive patients with CS (14 women and 5 men; mean age 45.84 ± 13.15 years) and sex-, age-matched 36 controls (25 women and men; mean age 52.47 ± 8.98 years). Anthropometric parameters, biochemical and hormonal data were compared between groups. Lumbar spine (L1–L4) and femoral neck BMD (LS BMD, FN BMD) measurements were performed. TBS values were obtained from lumbar spine DXA images.ResultsTBS was significantly lower in patients with CS compared to controls (p = 0.0002). The 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture were significantly higher in the CS group than in controls (p = 0.03, p < 0.0001, respectively). All subjects from the CS group with fractures had low TBS value (degraded microarchitecture). TBS correlated negatively with the duration of disease in patients with CS (r = -0.590 p = 0.008).ConclusionsThe patients with active CS have altered bone microstructure as indicated by the decreased TBS and are at higher risk of hip and a major osteoporotic fractures. TBS seems to be a very important analytical tool facilitating fracture risk assessment in endogenous hypercortisolism.

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Author response for "Bone microarchitecture assessed by Trabecular Bone Score is independent of mobility level or height in pediatric patients with cerebral palsy"

10.1002/jbmr.4047/v3/response1 ◽

2020 ◽

Author(s):

Mirko Rehberg ◽

Manuela Azim ◽

Kyriakos Martakis ◽

Renaud Winzenrieth ◽

Heike Hoyer‐Kuhn ◽

...

Keyword(s):

Cerebral Palsy ◽

Trabecular Bone ◽

Pediatric Patients ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Author Response

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DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis

Endocrine ◽

10.1007/s12020-021-02806-x ◽

2021 ◽

Author(s):

Enisa Shevroja ◽

Francesco Pio Cafarelli ◽

Giuseppe Guglielmi ◽

Didier Hans

Keyword(s):

Bone Mineral Density ◽

Trabecular Bone ◽

Bone Mineral ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Fragility Fractures ◽

Endocrine Disorders ◽

Mineral Density ◽

Increased Risk

AbstractOsteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone.

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