Spine bone texture assessed by trabecular bone score (TBS) in active and controlled acromegaly: a prospective study

Abstract Purpose Acromegalic patients have an increased vertebral fracture (VFx) risk due to bone quality reduction, independently of bone mineral density (BMD). Aim of the study is to describe bone quality in acromegaly, measured by Trabecular bone score (TBS), a non-invasive index for assessing bone microarchitecture. Methods We collected data of 18 patients (13 F, age 56.2±15 years) newly diagnosed with acromegaly. Thirty-six age-and gender matched healthy controls were also recruited. Pituitary function, bone and calcium-phosphorous metabolism, and BMD at spine and femur and TBS (by dual-X-ray absorptiometry) were assessed in acromegalic patients at diagnosis and 12 months after the achievement of IGF-1 normalization. Results At diagnosis, BMD and the VFx prevalence were comparable between patients and controls (28.3 ± 5.9 vs 27.6 ± 3.7 and 11% vs 8.3%), while TBS was significantly lower in acromegalic patients (1.20±0.13 vs 1.30±0.06; p<0.001) and CTX and osteocalcin were significantly higher compared to controls (707±365.7 vs 371±104.1 pg/ml; p=0.001 and 31.6 ± 15.4 vs 17.0 ± 5.7 ng/ml; p=0.001 respectively). One year after IGF-1 normalization, a significant reduction of bone turnover indexes in the group of acromegalic patients surgically cured (osteocalcin decreased of 61.2%, CTX decreased of 60.3%) compared to the ones controlled by medical therapy was observed (osteocalcin decreased of 39%, CTX decreased of 40.7%; p= 0.01 and p=0.001, respectively). Despite these findings, no TBS or BMD variations were observed. Conclusions Acromegalic patients have an impaired bone quality despite normal density. Achieving normal GH secretion rapidly leads to the normalization of bone turnover.

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Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism

Acta Endocrinologica ◽

10.1530/eje-13-0305 ◽

2013 ◽

Vol 169 (2) ◽

pp. 155-162 ◽

Cited By ~ 73

Author(s):

Cristina Eller-Vainicher ◽

Marcello Filopanti ◽

Serena Palmieri ◽

Fabio Massimo Ulivieri ◽

Valentina Morelli ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Trabecular Bone ◽

Bone Quality ◽

Trabecular Bone Score ◽

Dual Energy ◽

Mineral Density ◽

Texture Measurement ◽

X Ray ◽

Spinal Radiograph ◽

And Gender

ObjectiveIn primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture.DesignWe studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph.ResultsPHPT patients had lower TBS (−2.39±1.8) and higher VFx prevalence (43.5%) than controls (−0.98±1.07 and 8.2% respectively, bothP<0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1–1.9,P=0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (+47±44.8,+29.2±34.1,+49.4±48.7 and +30.2±39.3% respectively, allP<0.0001). Among patients treated conservatively, TBS decreased significantly in those (n=3) with incident VFx (−1.3±0.3) compared with those without (−0.01±0.9,P=0.048), while BMD changes were not statistically different (LS 0.3±1.2 vs −0.8±0.9 respectively,P=0.19; TH 0.4±0.8 vs −0.8±1.4 respectively,P=0.13 and FN 0.4±0.9 vs −0.8±1.4 respectively,P=0.14).ConclusionsIn PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.

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Evaluation of bone quality, measured by trabecular bone score in patients with primary hyperparathyroidism

Problems of Endocrinology ◽

10.14341/probl201662571 ◽

2016 ◽

Vol 62 (5) ◽

pp. 71

Author(s):

Isabel Huguet ◽

Miguel Sampedro-Núñez ◽

Jose Luis Muñoz de Nova ◽

Ana Ramos-Levi ◽

Eugenio Escolano ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Trabecular Bone ◽

Bone Quality ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Surrogate Marker ◽

Time Lapse ◽

Mineral Density ◽

One Year ◽

Clinical Records

Introduction. Evaluation of bone quality represents a clinical challenge. Analysis of bone mineral density (BMD) provides useful, but incomplete, information, and new tools are needed. Trabecular Bone Score (TBS) is emerging as a new surrogate marker of bone texture and microarchitecture and, may, therefore, be useful to potentially evaluate the risk of osteoporosis.Materials and methods. Retrospective study of 18 patients with primary hyperparathyroidism. Clinical, analytical and BMD data were collected form clinical records. TBS was calculated by reevaluating the already existing BMD images. Patients were classified into two different groups according to their treatment: 1) 10 patients who underwent surgery, in whom TBS was evaluated before (B-S) and after surgery (A-S), and 2) 8 patients who received standard medical treatment, in whom TBS was evaluated with a time-lapse of one year.Results. Basal age, body mass index (BMI), serum calcium, PTH and vitamin 25-OH-D levels, and T-Scores were not significantly different between the two groups. We observed a significant improvement of TBS one year after surgery in the first group (TBS B-S 1.24±0.13 vs TBS A-S 1.29±0.11,p=0.03). A subtle deterioration on TBS was observed one year after standard treatment in the second group (1.25±0.7 vs 1.22±0.7, p=0.29). Overall, surgical patients experienced a TBS increase 4.2%, whilst a decrease of 1.6% was observed in the second group (p=0.026)Conclusion. Bone microarchitecture, measured by TBS, improves after surgery in patients with primary hyperparathyroidism. This parameter seems promising in the evaluation of bone status in primary hyperparathyroidism. Larger and longer follow-up studies deem necessary to better evaluate the potential utilities of using TBS in the assessment of bone quality.

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Trabecular Bone Score, Bone Mineral Density and Bone Markers in Patients with Primary Hyperparathyroidism 2 Years After Parathyroidectomy

Hormone and Metabolic Research ◽

10.1055/a-0850-8679 ◽

2019 ◽

Vol 51 (03) ◽

pp. 186-190 ◽

Cited By ~ 8

Author(s):

Gonzalo Miguel ◽

Federico Carranza ◽

Juan Rodríguez ◽

Mercedes Ramos ◽

David Pablos ◽

...

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Primary Hyperparathyroidism ◽

Bone Turnover ◽

Trabecular Bone ◽

Bone Turnover Markers ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Mineral Density ◽

Turnover Markers

AbstractFollowing a parathyroidectomy there is a bone mineral density (BMD) improvement in patients with primary hyperparathyroidism. However, data of bone microarchitecture are scarce. Trabecular bone score (TBS) estimates bone microarchitecture and could provide valuable information in those patients. The aim of this study is to assess TBS changes 2 years after successful surgery in a group of patients with primary hyperparathyroidism and correlate these results with changes in BMD and bone turnover markers. This is a prospective study including 32 patients. In all participants BMD and TBS were measured, before and 24 months after surgery. Biochemical data: serum calcium, PTH, 25-OH-vitamin D, beta-crosslaps, bone alkaline phosphatase, and osteocalcin. 25 female and 7 male patients, mean age 64.6±12.4 years, were included in the study. At baseline, BMD was low at: lumbar spine (T-score −2.19±1.31), total hip (−1.33±1.12), femoral neck (−1.75±0.84), and distal one-third radius (−2.74±1.68). Baseline TBS showed partially degraded microarchitecture (1.180±0.130). After parathyroidectomy lumbar spine BMD increased significantly (5.3±13.0%, p<0.05), as well as total hip (3.8±8.8%, p<0.05). There was an increase in TBS, but this was not significant. There was a correlation between TBS and BAP at baseline (rs=0.73; p<0.01) and TBS and BAP 2 years after surgery (rs=0.57, p<0.05). Although bone density improves 2 years after surgery in patients with primary hyperparathyroidism and there is a restoration of bone turnover markers, TBS is not completely restored. These results remark the necessity of longer periods of study, to confirm if bone microarchitecture could be completely restored after surgery.

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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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Trabecular bone scores in young HIV-infected men: a matched case-control study

10.21203/rs.2.16155/v4 ◽

2020 ◽

Author(s):

Youn Jeong Kim ◽

Kwi Young Kang ◽

Juyoung Shin ◽

Yoonhee Jun ◽

Sang Il Kim ◽

...

Keyword(s):

Lumbar Spine ◽

Trabecular Bone ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Cross Sectional Study ◽

Mineral Density ◽

Trabecular Microarchitecture ◽

Cross Sectional ◽

Young Males ◽

Matched Case

Abstract Background Screening for osteoporosis with dual-energy X-ray absorptiometry (DXA) is recommended for male HIV-infected patients only above the age of 50. Recently, trabecular bone score (TBS) has been introduced as a novel tool to assess bone microarchitecture using DXA of the lumbar spine. Few studies have reported TBS values in HIV-infected individuals younger than 50 years of age. This study compared TBS values in young males infected with HIV and matched controls, and investigated the associations between TBS and demographic parameters, clinical parameters, and bone mineral density (BMD) scores. Methods A cross-sectional study of BMD and TBS in HIV-infected men (n = 80) aged between 18 and 50 years and age- and sex-matched controls (n = 80) was conducted. Results The proportion of patients with low BMD (Z-score ≤−2) was significantly greater among HIV-infected patients than among matched controls (21.3% [17/80] vs. 8.8% [7/80], p = 0.027). Mean TBS values were significantly lower in HIV-infected patients than in controls (1.41 ± 0.07 vs. 1.45 ± 0.07, p = 0.008). In both groups, TBS values were positively correlated with BMD at the lumbar spine, femoral neck, and total hip (p < 0.001); however, TBS was not correlated with body mass index. In the HIV group, TBS was negatively correlated with the duration of tenofovir disoproxil fumarate(TDF) exposure (p = 0.04). Conclusion Young men infected with HIV had abnormal bone trabecular microarchitecture, as assessed by both TBS and BMD. TBS values were correlated with both BMD and the duration of TDF exposure.

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TRABECULAR BONE SCORE – A NON-INVASIVE ANALYTICAL METHOD TO EVALUATE BONE QUALITY BASED ON ROUTINE DUAL-ENERGY ABSORPTIOMETRY. PERSPECTIVES OF ITS USE IN CLINICAL PRACTICE

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2016-44-4-23-24 ◽

2016 ◽

Vol 44 (4) ◽

pp. 462-476

Author(s):

T. T. Tsoriev ◽

Zh. E. Belaya ◽

G. A. Mel'nichenko

Keyword(s):

Computed Tomography ◽

Clinical Practice ◽

Trabecular Bone ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Dual Energy ◽

Secondary Osteoporosis ◽

Mineral Density ◽

Non Invasive ◽

Physical Measurements

Two-dimensional dual-energy X-ray absorptiometry (DXA, osteodensitometry) is currently considered as the gold standard for diagnosis of osteoporosis. However, despite good operational characteristics, this type of investigation cannot help to assess bone microarchitecture and the degree of its derangement in osteoporosis. Therefore, trabecular bone score (TBS) has been developed as a non-invasive method of indirect description of bone microarchitecture based on data derived from a standard DXA of the lumbar spine. Not being a direct mapping of the physical measurements of trabecular microarchitecture, TBS nevertheless shows a positive correlation with quantitative values obtained from micro-computed tomography and high resolution peripheral quantitative computed tomography, i.e. with the bone volume fraction, junction density, trabecular numbers and their disintegration. There is also an association between the ability of the bone tissue to resist stress in experimental studies ex vivo and TBS measurement. Due to TBS, there is a possibility to detect bone microarchitecture impairment even in individuals with normal bone mineral density (BMD), i.e. higher TBS values correlate with improved bone microstructure, whereas a reduced TBS shows its deterioration. Limitation of TBS use are primarily related to the DXA image quality: image faults caused either by technical reasons or by too low or too high body mass index can lead to an overestimation/underestimation of the index. Assessment of the lumbar TBS has been repeatedly performed in cross-sectional and prospective studies in representative patient samples (mainly postmenopausal women) and significant numbers of healthy subjects, and proved to be a predictor (independent of BMD) of fracture risk. An evaluation of the possibility to use TBS for early diagnosis of secondary osteoporosis (related to various endocrine disorders) would be of great interest, as BMD, as known from clinical practice, is not always a reliable measurement of the bone endurance, especially in diabetes, steroid osteoporosis and acromegaly. The use of TBS along with BMD as a marker of efficacy of current treatment for secondary osteoporosis is also possible, but it is not yet evidence-based; therefore, research has to be continued.

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Similarities and differences between bone quality parameters, trabecular bone score and femur geometry

PLoS ONE ◽

10.1371/journal.pone.0260924 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0260924

Author(s):

Kyong Young Kim ◽

Kyoung Min Kim

Keyword(s):

Trabecular Bone ◽

Cortical Bone ◽

Bone Quality ◽

Cortical Thickness ◽

Trabecular Bone Score ◽

Quality Parameters ◽

Mineral Density ◽

Men And Women ◽

Similarities And Differences ◽

Femur Geometry

Bone quality is a critical factor that, along with bone quantity, determines bone strength. Image-based parameters are used for assessing bone quality non-invasively. The trabecular bone score (TBS) is used to assess quality of trabecular bone and femur geometry for cortical bone. Little is known about the associations between these two bone quality parameters and whether they show differences in the relationships with age and body mass index (BMI). We investigated the associations between the trabecular bone score (TBS) and femur cortical geometry. Areal bone mineral density (BMD) was assessed using dual energy X-ray absorptiometry (DXA) and the TBS was assessed using iNsight software and, femur geometry using APEX (Hologic). A total of 452 men and 517 women aged 50 years and older with no medical history of a condition affecting bone metabolism were included. Z-scores for TBS and cortical thickness were calculated using the age-specific mean and SD for each parameter. A ‘discrepancy group’ was defined as patients whose absolute Z-score difference between TBS and cortical thickness was > 1 point. TBS and cortical thickness correlated negatively with age both in men and women, but the associations were stronger in women. Regarding the associations with BMI, TBS provided significant negative correlation with BMI in the range of BMI > 25 kg/m2. By contrast, cortical thickness correlated positively with BMI for all BMI ranges. These bone quality-related parameters, TBS and cortical thickness, significantly correlated, but discordance between these two parameters was observed in about one-third of the men and women (32.7% and 33.4%, respectively). Conclusively, image-based bone quality parameters for trabecular and cortical bone exhibit both similarities and differences in terms of their associations with age and BMI. These different profiles in TBS and FN cortical thickness might results in different risk profiles for the vertebral fractures or hip fractures in a certain percentage of people.

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DOES BASELINE PTH INFLUENCE RECOVERY OF BONE MINERAL DENSITY, TRABECULAR BONE SCORE AND BONE TURNOVER MARKERS? A PROSPECTIVE STUDY FOLLOWING CURATIVE PARATHYROIDECTOMY IN PRIMARY HYPERPARATHYROIDISM

Endocrine Practice ◽

10.4158/ep-2020-0148 ◽

2020 ◽

Vol 26 (12) ◽

pp. 1442-1450

Author(s):

Shrinath Shetty ◽

Kripa Elizabeth Cherian ◽

Sahana Shetty ◽

Nitin Kapoor ◽

Felix K. Jebasingh ◽

...

Keyword(s):

Bone Mineral Density ◽

Primary Hyperparathyroidism ◽

Bone Turnover ◽

Prospective Study ◽

Trabecular Bone ◽

Bone Mineral ◽

Bone Turnover Markers ◽

Trabecular Bone Score ◽

Mineral Density ◽

Turnover Markers

Objective: This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery. Methods: This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery. Results: Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638 ± 0.093 versus 0.698 ± 0.041 g/cm2; P = .01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH. Conclusion: The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score

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Bone density, microarchitecture and tissue quality after 1 year of treatment with dolutegravir/abacavir/lamivudine

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa254 ◽

2020 ◽

Vol 75 (10) ◽

pp. 2998-3003

Author(s):

Jade Soldado-Folgado ◽

Elisabeth Lerma-Chippirraz ◽

Itziar Arrieta-Aldea ◽

Daniel Bujosa ◽

Natalia García-Giralt ◽

...

Keyword(s):

Trabecular Bone ◽

Bone Tissue ◽

Bone Quality ◽

Bone Health ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Tissue Quality ◽

Art Initiation ◽

The Impact ◽

Health Parameters

Abstract Background Bone mineral density (BMD) decreases with ART initiation with a tenofovir disoproxil fumarate-containing regimen, although bone tissue quality increases. The impact of dolutegravir (DTG)/abacavir (ABC)/lamivudine (3TC)-based ART initiation on bone health parameters is not clear. Objectives To study the impact of DTG/ABC/3TC-based therapy on bone health parameters in ART-naive individuals with HIV after 48 weeks of treatment. Methods An observational, prospective and analytical study of treatment-naive patients with HIV undergoing a DTG/ABC/3TC-based regimen at 48 week follow-up. Changes in bone strength parameters (BMD, bone microarchitecture and bone tissue quality) were assessed with non-parametric methods. Results Sixteen HIV-infected ART-naive patients starting DTG/ABC/3TC were included. BMD in the lumbar spine showed a significant decrease of −2.25% (P = 0.007) and −4.1% in the femoral neck (P = 0.007). Bone microarchitecture, as measured by trabecular bone score, also decreased significantly by −2.5% (P = 0.03). In contrast, bone quality [bone material strength index (BMi)], as measured by microindentation, significantly increased with respect to baseline after 48 weeks of treatment, showing better bone properties of +6.53% (P < 0.001). No significant changes were found in bone turnover markers. In addition, a positive significant correlation between the CD4/CD8 cell count ratio at baseline and changes in BMSi after 48 weeks of treatment was observed (Spearman’s rho = 0.4974; P = 0.04). Conclusions After a 48 week treatment with DTG/ABC/3TC-based ART, BMD and trabecular bone score decreased while bone tissue quality, as measured by microindentation, improved significantly. The state of the immune system at ART initiation is related to bone quality recovery. An overarching approach to assess bone toxicity in ART-treated patients is needed.

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