scholarly journals Pathophysiology of Growth Hormone Secretion Disorders and Their Impact on Bone Microstructure as Measured by Trabecular Bone Score

2019 ◽  
pp. S121-S129 ◽  
Author(s):  
M. KUŽMA ◽  
Z. KILLINGER ◽  
P. JACKULIAK ◽  
P. VAŇUGA ◽  
D. HANS ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Bone Quality ◽  
Bone Growth ◽  
Trabecular Bone Score ◽  
Bone Matrix ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Mineral Density

This article is focused on endocrine-mediated osteoporosis caused by growth hormone (GH) disorders; adult GH deficiency and acromegaly. GH and insulin like growth factor-1 (IGF-1) stimulate linear bone growth through complex hormonal interactions and activates epiphyseal prechondrocytes. GH, via receptor activator of nuclear factor-kappaB (RANK), its ligand (RANK-L), and the osteoprotegerin system, stimulates production of osteoprotegerin and its accumulation in bone matrix. Malfunction of this mechanism, could lead to specific bone impairment. However, the primary problem of bone disease in GH secretion disorders is the primary prevention of osteoporotic fractures, so it is important to determine bone quality that better reflects the patient's actual predisposition to fracture. A method estimating bone quality from lumbar spine dual X-ray absorptiometry (DXA) scans is trabecular bone score (TBS). TBS in addition to bone mineral density (BMD) is a promising predictor of the osteoporotic fracture risk in women with postmenopausal osteopenia. In acromegaly TBS better defines risk of fracture because BMD is normal or even increased. TBS helps to monitor the effect of growth hormone therapy. Despite these findings, TBS shouldn´t be used alone, but a comprehensive consideration of all fracture risk factors, BMD and bone turnover markers is necessary.

scholarly journals Bone Mineral Density Compared to Trabecular Bone Score in Primary Hyperparathyroidism

2022 ◽  
Vol 11 (2) ◽  
pp. 330
Author(s):  
Alicia R. Jones ◽  
Koen Simons ◽  
Susan Harvey ◽  
Vivian Grill
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Primary Hyperparathyroidism ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Bone Quality ◽  
Bone Mineral ◽  
Trabecular Bone Score ◽  
Statistical Significance ◽  
Mineral Density

Individuals with primary hyperparathyroidism (PHPT) have reduced bone mineral density (BMD) according to dual X-ray absorptiometry at cortical sites, with relative sparing of trabecular BMD. However, fracture risk is increased at all sites. Trabecular bone score (TBS) may more accurately describe their bone quality and fracture risk. This study compared how BMD and TBS describe bone quality in PHPT. We conducted a retrospective cross-sectional study with a longitudinal component, of adults with PHPT, admitted to a tertiary hospital in Australia over ten years. The primary outcome was the TBS at the lumbar spine, compared to BMD, to describe bone quality and predict fractures. Secondary outcomes compared changes in TBS after parathyroidectomy. Of 68 included individuals, the mean age was 65.3 years, and 79% were female. Mean ± SD T-scores were −1.51 ± 1.63 at lumbar spine and mean TBS was 1.19 ± 0.12. Only 20.6% of individuals had lumbar spine BMD indicative of osteoporosis, while 57.4% of TBS were ≤1.20, indicating degraded architecture. There was a trend towards improved fracture prediction using TBS compared to BMD which did not reach statistical significance. Comparison of 15 individuals following parathyroidectomy showed no improvement in TBS.

Trabecular Bone Score in Thais with or without Type 2 Diabetes

2020 ◽  
Vol 103 (11) ◽  
pp. 1131-1137
Keyword(s):  
Diabetes Mellitus ◽  
Bone Mineral Density ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Trabecular Bone Score ◽  
Mineral Density ◽  
Men And Women

Background: When compared to people without type 2 diabetes mellitus (T2DM), people with T2DM have an increase in fracture risk despite having higher bone mineral density (BMD). Many studies in Caucasians demonstrated that trabecular bone score (TBS) is lower in people with T2DM than those without. The utility of TBS as a fracture risk assessment tool in Asians with T2DM is currently unclear. Objective: To compared lumbar spine (LS) BMD and TBS in Thais with or without T2DM and investigate the correlation between TBS and hemoglobin A1c (HbA1c) and diabetes duration in participants with T2DM. Materials and Methods: The present study was a cross-sectional study that included 97 participants with T2DM (37 men and 60 women) and 342 participants without T2DM (174 men and 168 women). LS-BMD and TBS were obtained. Results: Men and women with T2DM were older and had higher body mass index (BMI). Men with T2DM had significant higher LS-BMD (1.051±0.166 versus 0.972±0.125, p=0.009) and non-significant lower TBS (1.333±0.084 versus 1.365±0.096, p=0.055) than those without. Similarly, women with T2DM had significant higher LS-BMD (0.995±0.155 versus 0.949±0.124, p=0.021) and lower TBS (1.292±0.105 versus 1.382±0.096, p<0.001). After adjusting for age and BMI, T2DM predicted higher BMD in men (p<0.001), but not in women (p=0.143). T2DM was not associated with TBS after adjusting for age and BMI in both genders (p=0.403 and p=0.151 in men and women, respectively). TBS did not correlate with HbA1c in both genders. However, TBS was non-significantly associated with diabetes duration in women (p=0.073), but not in men (p=0.639). Conclusion: T2DM significantly predicted higher LS-BMD only in men and was not independently associated with TBS in both genders. These data highlighted that, in T2DM, there was some variation in the clinical usefulness of BMD and TBS in predicting osteoporotic fractures with regard to clinical characteristic of participants. Keywords: Bone mineral density, Type 2 diabetes mellitus, Trabecular bone score

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

PLoS ONE ◽  
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.

scholarly journals Bone quality: what is it and how is it measured?

2006 ◽  
Vol 50 (4) ◽  
pp. 579-585 ◽  
Author(s):  
Juliet Compston
Keyword(s):  
Bone Mineral Density ◽  
Bone Turnover ◽  
Fracture Risk ◽  
Bone Strength ◽  
Bone Quality ◽  
Bone Mineral ◽  
Bone Matrix ◽  
Mineral Density ◽  
New Techniques ◽  
Composition And Structure

Bone quality describes aspects of bone composition and structure that contribute to bone strength independently of bone mineral density. These include bone turnover, microarchitecture, mineralisation, microdamage and the composition of bone matrix and mineral. New techniques to assess these components of bone quality are being developed and should produce important insights into determinants of fracture risk in untreated and treated disease.

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 The Long-Term Effects of Growth Hormone Replacement on Bone Mineral Density and Trabecular Bone Score: Results of the 10-Year Prospective Follow-up

2021 ◽  
pp. S61-S68
Author(s):  
P. Vaňuga ◽  
M. Kužma ◽  
D. Stojkovičová ◽  
J. Smaha ◽  
P. Jackuliak ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Growth Hormone ◽  
Trabecular Bone ◽  
Replacement Therapy ◽  
Bone Mineral ◽  
Trabecular Bone Score ◽  
Mineral Density ◽  
Gh Replacement

There are only few studies concerning about long-term effect of growth hormone (GH) replacement therapy on bone mineral density and bone microstructure. To assess effect of GH replacement therapy on bone mineral density (BMD) and trabecular bone score (TBS) in adult GH deficient (AGHD) subjects over period of 10 years. From 2005 to 2018, a prospective study of AGHD patients was conducted in national referral center for treatment of GHD. All patients received subcutaneous recombinant human GH in an IGF 1-normalizing regimen once a day. Lumbar spine (L-spine) and total hip (TH) BMD using Hologic densitometers were measured at baseline and every two years during treatment with rhGH. TBS was derived from L1-L4 DXA using iNsight® software (Medimaps, France) at each time point. Periods of measurement were baseline, year 2; 4; 6; 8 and 10. In total, 63 patients (38 males, 25 females, mean age 25.1±16 years) were included in the study. After 10 years of GH treatment, IGF-1 significantly increased (~35 %), with greatest increase at year 2. During 10-year follow-up, L-spine BMD increased approximately of 7 % (NS). TH BMD increase of 11 % during follow-up (p=0.0003). The greatest increment of BMD was achieved at year 6 on both sites, L-spine (+6 %) and TH BMD (+13 %) (p<0.05). There was no significant change of TBS during whole follow-up. In this study, sustaining positive effect of GH replacement therapy on bone density in subjects with adult GH deficiency over 10 years of follow-up was observed. The study did not show effect on TBS, as indirect measure of trabecular bone microarchitecture.

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

2021 ◽  
Author(s):  
E Sala ◽  
E Malchiodi ◽  
G Carosi ◽  
E Verrua ◽  
E Cairoli ◽  
...  
Keyword(s):  
Bone Turnover ◽  
Trabecular Bone ◽  
Bone Quality ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Normal Density ◽  
Mineral Density ◽  
Gh Secretion ◽  
And Gender ◽  
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&lt;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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