scholarly journals 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

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.

Trabecular Bone Score (TBS) in Clinical Practice – Rewiev

2018 ◽  
Vol 20 (5) ◽  
pp. 347-359 ◽  
Author(s):  
Maja Warzecha ◽  
Edward Czerwiński ◽  
Jarosław Amarowicz ◽  
Małgorzata Berwecka
Keyword(s):  
Risk Assessment ◽  
Differential Diagnosis ◽  
Clinical Practice ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Bone Structure ◽  
Trabecular Bone Score ◽  
World Health ◽  
Secondary Osteoporosis ◽  
Mineral Density

Bone mineral density (BMD) assessment is the basic method for assessing fracture risk and diagnosing osteoporosis according to the World Health Organization (WHO). Osteoporosis is diagnosed when the T-score at the proximal femur or spine is T≤-2.5; however, 70% of fractures occur in patients who do not fulfil this criterion. As BMD alone does not adequately predict fracture risk, additional methods supporting risk assessment are needed [3,4]. In 2012, the US Food and Drug Administration (FDA) adopted the Trabecular Bone Score (TBS) as another diagnostic method for osteoporosis. The aim of this study is to evaluate the use of TBS in clinical practice with particular attention to fracture risk assessment, differential diagnosis and assessment of treatment outcomes in patients suffering from primary or secondary osteoporosis. Literature analysis points to the increasing use of TBS in clinical practice. It has been found that, in different subjects with the same BMD, structural bone health is better differentiated using TBS. Additionally, it is valuable to use the DXA along with TBS analysis for improved prediction of fracture risk. Indirect assessment of bone structure with TBS is also helpful in assessing the effect of medications. In conclusion, TBS analysis is a valuable tool in the assessment of bone fracture risk and in the differential diagnosis of structural bone disorders in secondary osteoporosis.

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

Endocrine ◽  
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.

Optimizing DXA to Assess Skeletal Health: Key Concepts for Clinicians

2020 ◽  
Vol 105 (12) ◽  
pp. 3784-3791
Author(s):  
Kurt A Kennel ◽  
Jad G Sfeir ◽  
Matthew T Drake
Keyword(s):  
Fracture Risk ◽  
Trabecular Bone ◽  
Trabecular Bone Score ◽  
Evidence Synthesis ◽  
Dual Energy ◽  
Care Providers ◽  
Mineral Density ◽  
Skeletal Health ◽  
X Ray ◽  
Osteoporosis Care

Abstract Context The diagnosis of osteoporosis and assessment of fracture risk prior to a sentinel fracture was transformed by the widespread clinical use of dual-energy X-ray absorptiometry (DXA) for the assessment of bone mineral density (BMD). Evidence Acquisition This review is based on a collection of primary and review literature gathered from a PubMed search of “dual energy X-ray absorptiometry,” “trabecular bone score,” and “atypical femur fracture” among other keywords. PubMed searches were supplemented by the authors’ prior knowledge of the subject. Evidence Synthesis While uncertainty exists for some aspects of osteoporosis care, patient and clinician familiarity with BMD assessment for screening and monitoring is firmly established. Beyond BMD, lateral spine images obtained with DXA can diagnose osteoporosis and refine fracture risk through the detection of unrecognized vertebral fractures. In addition, analysis of DXA lumbar spine images can reflect changes in trabecular bone microarchitecture, a component of bone “quality” that predicts risk of fracture independent of BMD. Finally, monitoring of bone health by DXA may be extended to include assessment of the femoral cortices for rare but serious adverse effects associated with antiresorptive therapies. Conclusions Increasing technologic sophistication requires additional consideration for how DXA imaging is performed, interpreted and applied to patient care. As with any test, clinicians must be familiar with DXA performance, pitfalls in analysis, and interpretation within each clinical context in which DXA is applied. With this perspective, care providers will be well positioned to contribute to continuous improvement of DXA performance and, in turn, quality of osteoporosis care.

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

2013 ◽  
Vol 169 (2) ◽  
pp. 155-162 ◽  
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.

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

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.

scholarly journals Relationship between Insulin Resistance (HOMA-IR), Trabecular Bone Score (TBS), and Three-Dimensional Dual-Energy X-ray Absorptiometry (3D-DXA) in Non-Diabetic Postmenopausal Women

2020 ◽  
Vol 9 (6) ◽  
pp. 1732
Author(s):  
Francisco Campillo-Sánchez ◽  
Ricardo Usategui-Martín ◽  
Ángela Ruiz -de Temiño ◽  
Judith Gil ◽  
Marta Ruiz-Mambrilla ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Trabecular Bone ◽  
Postmenopausal Women ◽  
Trabecular Bone Score ◽  
Three Dimensional ◽  
Dual Energy ◽  
Enzyme Linked Immunosorbent Assay ◽  
Model Assessment ◽  
Mineral Density ◽  
X Ray

Background: Insulin may play a key role in bone metabolism, where the anabolic effect predominates. This study aims to analyze the relationship between insulin resistance and bone quality using the trabecular bone score (TBS) and three-dimensional dual-energy X-ray absorptiometry (3D-DXA) in non-diabetic postmenopausal women by determining cortical and trabecular compartments. Methods: A cross-sectional study was conducted in non-diabetic postmenopausal women with suspected or diagnosed osteoporosis. The inclusion criteria were no menstruation for more than 12 months and low bone mass or osteoporosis as defined by DXA. Glucose was calculated using a Hitachi 917 auto-analyzer. Insulin was determined using an enzyme-linked immunosorbent assay (EIA). Insulin resistance was estimated using a homeostasis model assessment of insulin resistance (HOMA-IR). DXA, 3D-DXA, and TBS were thus collected. Moreover, we examined bone parameters according to quartile of insulin, hemoglobin A1C (HbA1c), and HOMA-IR. Results: In this study, we included 381 postmenopausal women. Women located in quartile 4 (Q4) of HOMA-IR had higher values of volumetric bone mineral density (vBMD) but not TBS. The increase was higher in the trabecular compartment (16.4%) than in the cortical compartment (6.4%). Similar results were obtained for insulin. Analysis of the quartiles by HbA1c showed no differences in densitometry values, however women in Q4 had lower levels of TBS. After adjusting for BMI, statistical significance was maintained for TBS, insulin, HOMA-IR, and HbA1c. Conclusions: In non-diabetic postmenopausal women there was a direct relationship between insulin resistance and vBMD, whose effect is directly related to greater weight. TBS had an inverse relationship with HbA1c, insulin, and insulin resistance unrelated to weight. This might be explained by the formation of advanced glycosylation products (AGEs) in the bone matrix, which reduces bone deformation capacity and resistance, as well as increases fragility.

scholarly journals Trabecular Bone Score Reflects Trabecular Microarchitecture Deterioration and Fragility Fracture in Female Adult Patients Receiving Glucocorticoid Therapy: A Pre-Post Controlled Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Mei-Hua Chuang ◽  
Tzyy-Ling Chuang ◽  
Malcolm Koo ◽  
Yuh-Feng Wang
Keyword(s):  
Trabecular Bone ◽  
Assessment Tool ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Fragility Fractures ◽  
Glucocorticoid Therapy ◽  
Analysis Of Covariance ◽  
Controlled Study ◽  
Mineral Density ◽  
Trabecular Microarchitecture

A recently developed diagnostic tool, trabecular bone score (TBS), can provide quality of trabecular microarchitecture based on images obtained from dual-energy X-ray absorptiometry (DXA). Since patients receiving glucocorticoid are at a higher risk of developing secondary osteoporosis, assessment of bone microarchitecture may be used to evaluate risk of fragility fractures of osteoporosis. In this pre-post study of female patients, TBS and fracture risk assessment tool (FRAX) adjusted with TBS (T-FRAX) were evaluated along with bone mineral density (BMD) and FRAX. Medical records of patients with (n=30) and without (n=16) glucocorticoid treatment were retrospectively reviewed. All patients had undergone DXA twice within a 12- to 24-month interval. Analysis of covariance was conducted to compare the outcomes between the two groups of patients, adjusting for age and baseline values. Results showed that a significant lower adjusted mean of TBS (p=0.035) and a significant higher adjusted mean of T-FRAX for major osteoporotic fracture (p=0.006) were observed in the glucocorticoid group. Conversely, no significant differences were observed in the adjusted means for BMD and FRAX. These findings suggested that TBS and T-FRAX could be used as an adjunct in the evaluation of risk of fragility fractures in patients receiving glucocorticoid therapy.

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