scholarly journals Nutritional Status and Bone Microarchitecture in a Cohort of Systemic Sclerosis Patients

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1632
Author(s):  
Sabrina Paolino ◽  
Greta Pacini ◽  
Carlotta Schenone ◽  
Massimo Patanè ◽  
Alberto Sulli ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Autonomic Nerve ◽  
Quality Data ◽  
Mineral Density ◽  
Bone Status ◽  
Immune System Activation ◽  
Gi Symptoms ◽  
Espen Criteria

Systemic sclerosis (SSc) is a connective tissue disease characterized by initial microvascular damage, immune system activation and progressive fibrosis with insufficiency of internal organs. Gastrointestinal (GI) involvement is characterized by atrophy of the smooth muscle and small bowel hypomotility, mainly resulting from an autonomic nerve dysfunction. These modifications significantly affect gut transit and nutrient absorption, thus leading to malnutrition deficit induced by malabsorption. Nutritional deficit induced by malabsorption might also lead to bone alterations. This study aims to evaluate the relationship between malnutrition and bone status. Thirty-six postmenopausal female patients fulfilling the ACR 2013 criteria for SSc underwent dual-energy X-ray absorptiometry scan (DXA) to detect quantitative lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) analysis to detect bone quality. Data from DXA also allow to assess body composition and provide several quantitative parameters, including free fat mass index (FFMI) that identifies the patient with malnutrition (values <15 kg/m2 in women and 17 kg/m2 in men), according to the ESPEN criteria. Body mass index (BMI) was calculated for all SSc patients and every patient completed a diary reporting GI symptoms. Two groups of SSc patients with or without diagnosed malnutrition according to FFMI parameter were identified. Malnourished SSc patients showed significantly lower weight (p = 0.01) and BMI (p = 0.001), as well as lower serum levels of hemoglobin (p = 0.009), albumin (p = 0.002), PTH (p = 0.02) and 25OH-vitamin D (p = 0.008). DXA analysis showed significantly lower lumbar L1-L4 T-score (p = 0.009) and BMD values (p = 0.029) in malnourished SSc patients. Consistently, TBS values were significantly lower in malnourished patients (p = 0.008) and correlated with BMD (at any site) and serum albumin levels (p = 0.02). In addition, FFMI positively correlated with bone parameters as well as with symptoms of intestinal impairment in malnourished SSc patients. Finally, GI symptoms significantly correlated with BMD but not with TBS. This pilot study shows that in malnourished SSc patients (2015 ESPEN criteria: FFMI<15 kg/m2), an altered bone status significantly correlates with GI involvement, in terms of symptoms being mainly due to intestinal involvement together with the presence of selected serum biomarkers of malnutrition.

scholarly journals Metabolic Profile and Bone Status in Post-Menopausal Women with Rheumatoid Arthritis: A Monocentric Retrospective Survey

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3168
Author(s):  
Sabrina Paolino ◽  
Elvis Hysa ◽  
Sabrina Atena Stoian ◽  
Emanuele Gotelli ◽  
Andrea Casabella ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Insulin Resistance ◽  
Disease Activity ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Significant Negative Correlation ◽  
Serum Concentrations ◽  
Mineral Density ◽  
Bone Status ◽  
Post Menopausal

Background: Rheumatoid arthritis (RA) and metabolic syndrome (MetS) are chronic conditions that share common inflammatory mechanisms. Both diseases can lead to an impairment of the bone microarchitecture. The aims of our study were to evaluate clinical, metabolic, and bone parameters in RA patients with or without MetS (MetS+, MetS−) and potential correlations between the glico-lipidic profile, RA disease activity, and bone status. Methods: A total of thirty-nine RA female post-menopausal patients were recruited (median age 66.6 ± 10.4, disease duration 3 ± 2.7). Anthropometric data, medical history, and current treatment were recorded along with basal blood tests, bone, and lipid metabolism biomarkers. RA disease activity and insulin resistance were evaluated through standard scores. Quantitative assessment of the bone (bone mineral density—BMD) was performed by dual-energy-X ray absorption (DXA), whereas bone quality was quantified with the trabecular bone score (TBS). Results: No statistically significant differences concerning both BMD and TBS were detected between the MetS+ and MetS− RA patients. However, the MetS+ RA patients exhibited significantly higher disease activity and lower serum 25-hydroxyvitamin D [25(OH)D] concentrations (respectively, p = 0.04 and p = 0.01). In all RA patients, a significant negative correlation emerged between the BMD of the femoral trochanter with plasmatic triglycerides (TG) concentrations (r = −0.38, p = 0.01), whereas the lumbar BMD was positively correlated with the abdominal waist (AW) and fasting glucose (FG) concentrations. On the other hand, the TBS was negatively correlated with insulin concentrations, FG, and RA disease activity (respectively, r = −0.45, p = 0.01, r = −0.40, p = 0.03, r = −0.37, p = 0.04), the last one was further negatively correlated with 25-OHD serum concentrations (r = −0.6, p = 0.0006) and insulin-resistance (r = 0.3, p = 0.04). Conclusions: Bone quantity (BMD) and quality (TBS) do not seem significantly changed among MetS+ and MetS− RA patients; however, among MetS+ patients, both significantly higher disease activity and lower vitamin D serum concentrations were observed. In addition, the significant negative correlations between the alterations of metabolic parameters limited to the TBS in all RA patients might suggest that qualitative bone microarchitecture impairments (TBS) might manifest despite unchanged BMD values.

Trabecular Bone Score in Female Patients with Systemic Sclerosis: Comparison with Rheumatoid Arthritis and Influence of Glucocorticoid Exposure

2014 ◽  
Vol 42 (2) ◽  
pp. 228-235 ◽  
Author(s):  
Eugénie Koumakis ◽  
Jérôme Avouac ◽  
Renaud Winzenrieth ◽  
Emese Toth ◽  
Judith Payet ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Sclerosis ◽  
Trabecular Bone ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Bone Involvement ◽  
High Risk Population ◽  
Mineral Density ◽  
Female Patients ◽  
Increased Risk

Objective.Systemic sclerosis (SSc) is associated with an increased risk of osteoporosis and fractures. To date, the etiology of bone loss in SSc is unclear. Trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of areal bone mineral density (aBMD). The aims were to assess bone involvement in SSc using TBS in comparison with a “high-risk” population with rheumatoid arthritis (RA) and controls, and to investigate the determinants of a low TBS.Methods.This was a cross-sectional study of 65 women with SSc, 138 age-matched female patients with RA, and 227 age-matched female controls. Spine and hip aBMD were assessed using dual-energy X-ray absorptiometry. TBS was calculated from the anteroposterior image of the spine aBMD.Results.TBS was significantly lower in SSc compared to controls (p < 0.0001) and did not differ from RA (p = 0.128), despite lower cumulative and daily glucocorticoid (GC) dose (p < 0.0001). Further, patients with SSc receiving GC ≥ 5 mg/day had a significantly lower TBS than those receiving GC < 5 mg/day (p = 0.001). Multivariate analysis revealed that a low TBS was independently associated with daily GC dose (OR 5.6, 95% CI 1.7–19.2) and a T score ≤ −2.5 SD (OR 5.0, 95% CI 1.5–7.0) in SSc. No association between GC and TBS was found in RA.Conclusion.Our results support the development of a combined approach using both TBS and aBMD for the assessment of bone microarchitecture in inflammatory rheumatic diseases. Our study showed that SSc-related bone involvement is characterized by an impairment in bone quality in addition to reduced bone quantity, and highlights that TBS can identify the negative effect of GC on bone microarchitecture.

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.

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 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.

scholarly journals A Contemporary View of the Diagnosis of Osteoporosis in Patients With Axial Spondyloarthritis

2020 ◽  
Vol 7 ◽  
Author(s):  
Mie Jin Lim ◽  
Kwi Young Kang
Keyword(s):  
Axial Spondyloarthritis ◽  
Current Knowledge ◽  
Imaging Modality ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Imaging Techniques ◽  
Quantitative Computed Tomography ◽  
Density Measurement ◽  
Chronic Inflammatory Disease ◽  
Mineral Density

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the axial joints. Altered bone metabolism associated with chronic inflammation leads to both new bone formation in the spine and increased bone loss. It is known that patients with axSpA have a high prevalence of osteoporosis and fractures. However, there is no consensus on which imaging modality is the most appropriate for diagnosing osteoporosis in axSpA. Bone mineral density measurement using dual-energy X-ray absorptiometry is the primary diagnostic method for osteoporosis, but it has notable limitations in patients with axSpA. This method may lead to the overestimation of bone density in patients with axSpA because they often exhibit abnormal calcification of spinal ligaments or syndesmophytes. Therefore, the method may not provide adequate information about bone microarchitecture. These limitations result in the underdiagnosis of osteoporosis. Recently, new imaging techniques, such as high-resolution peripheral quantitative computed tomography, and trabecular bone score have been introduced for the evaluation of osteoporosis risk in patients with axSpA. In this review, we summarize the current knowledge regarding imaging techniques for diagnosing osteoporosis in patients with axSpA.

SAT0479 IMPACT OF TRABECULAR BONE SCORE ON INTERVENTION THRESHOLD FOR BONE SPARING THERAPY IN PATIENTS REFERRED FOR BONE MINERAL DENSITY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1196.1-1196
Author(s):  
C. Rakieh ◽  
S. Ho ◽  
R. Butler
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Intervention Threshold ◽  
Mineral Density ◽  
Major Osteoporotic Fracture ◽  
Treatment Threshold ◽  
T Score ◽  
Metabolic Bone

Background:Trabecular bone score (TBS) is an index of skeletal quality that has been validated as an independent risk factor for fracture and incorporated into fracture risk assessment (FRAX). TBS provides information on bone microarchitecture not captured from standard bone mineral density (BMD) measured by dual energy X-ray absorptiometry (DXA). Nonetheless, the clinical implications of using TBS in routine practice are not yet fully understood and warrant further evaluation.Objectives:To determine whether lumbar TBS can have an impact on clinician’s treatment threshold derived from DXA and clinical risk factors: does the addition of TBS to DXA measurements make the clinician more or less likely to recommend bone sparing therapy?Methods:A cross-sectional study at a tertiary metabolic bone centre in the West Midlands region of England. Three expert metabolic bone physicians, two rheumatologists and one elderly care, assessed consecutive patients referred for a DXA scan ± clinic review and provided treatment recommendations with and without TBS. Patients ≥ 18 years old with BMI of 15-37 who were not on bone sparing therapy were considered eligible. TBS was defined according to T-score as normal (T-score ≥ -1), moderate (-1 > T-score ≥ -2.5) or degraded (T-score ≤ -2.5). TBS groups were stratified by BMD T-scores (normal, osteopenia, or osteoporosis) using minimum T-score of total hip, femoral neck, and spine to identify categories in which TBS may be of more clinical use. The main outcome measure was the proportion of change in clinician’s treatment threshold between BMD alone and BMD plus TBS. The difference was assessed for significance using Chi-square test. Additionally, the change in UK National Osteoporosis Guideline Group (NOGG) threshold was also assessed using TBS-adjusted FRAX scores. Correlations between BMD-TBS strata and the change in intervention threshold (yes/no) were carried out using Spearman test.Results:540 patients were analysed. The inclusion of TBS resulted in 8.2% change in clinician’s treatment threshold (p <0.001) shifting the outcome 6.5 % for and 1.7 % against treatment. More than half of the cases in which the clinical decision was changed were for patients with osteopenia and degraded TBS (significant correlation; P <0.001). NOGG intervention threshold was changed in 7.4% of the cases (P<0.001); 6.1% for and 1.3% against treatment. 37.5% of NOGG changed outcome was related to osteopenia with degraded TBS (p<0.001). Kappa agreement between the clinician and NOGG was fair at 0.42 (p<0.001).Conclusion:These results demonstrate that using TBS in routine clinical practice is most likely to impact treatment decision in patients with osteopenia who have compromised bone microarchitecture. Incorporating TBS in routine DXA scans may lead to a net increase in bone protective therapy of approximately 5%. It is unknown whether adopting such an approach universally can reduce future fracture risk, and prospective studies are needed to address this question.References:[1]Hans D et al. J Bone Miner Res. 2011;26(11):2762-9.[2]McCloskey EV et al. Calcif Tissue Int. 2015;96(6):500-9.Table 1.Demographic and baseline characteristics (n = 540)Female470 (87%)Age (years)68.1 ± 11.6Body mass index (BMI)26.2 ± 4.6Femoral neck T-score-1.80 ± 1.04Total hip T-score-1.32 ± 1.07Lumbar spine T-score-1.37 ± 1.42Lumbar spine TBS1.32 ± 0.13Major osteoporotic fractures238 (44%)Spinal fractures81 (15%)FRAX major osteoporotic fracture14.43 ± 9.03FRAX hip fracture4.60 ± 6.20TBS-adjusted FRAX major osteoporotic fracture13.82 ± 8.80TBS-adjusted FRAX hip fracture4.45 ± 5.73Figure 1.Distribution of changed clinical treatment threshold in normal, moderate, and degraded TBS according to BMD T-scoreAcknowledgments:Bone density unit &Rheumatology team, Robert Jones and Agnes Hunt Orthopaedic HospitalDisclosure of Interests:None declared

SAT0454 Relationship Between Trabecular Bone Score and Bone Mineral Density in Systemic Sclerosis

2015 ◽  
Vol 74 (Suppl 2) ◽  
pp. 825.1-825
Author(s):  
G. Botticella ◽  
S. Paolino ◽  
A. Casabella ◽  
D. Fasciolo ◽  
B. Seriolo ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Systemic Sclerosis ◽  
Trabecular Bone ◽  
Bone Mineral ◽  
Trabecular Bone Score ◽  
Mineral Density

scholarly journals Association of Low Serum 25OHD Levels with Abnormal Bone Microarchitecture in Well-Differentiated Thyroid Cancer

2020 ◽  
Vol 8 (4) ◽  
pp. 49
Author(s):  
Federico Hawkins Carranza ◽  
Sonsoles Guadalix Iglesias ◽  
María Luisa De Mingo Dominguez ◽  
Gonzalo Allo Miguel ◽  
Cristina Martín-Arriscado Arroba ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Serum Levels ◽  
Bone Alkaline Phosphatase ◽  
Mineral Density ◽  
Serum 25Ohd ◽  
Hydroxyvitamin D ◽  
Long Term Follow Up ◽  
Low Serum

The association of low levels of 25 hydroxyvitamin D (25OHD) with papillary thyroid cancer (PTC) is being studied, as to whether it is a risk factor or as a coincidental one. This study aimed to evaluate serum levels of deficiency, insufficiency, and sufficiency of 25OHD in PTC and its relationship with the trabecular bone score (TBS) and bone mineral density (BMD). This study includes 134 postmenopausal women with PTC, followed for 10 years. BMD was measured with DXA Hologic QDR 4500, and TBS with Med-Imaps iNsight2.0 Software. Mean serum 25OHD was 23.09 ± 7.9 ng/mL and deficiency, insufficiency, and sufficiency levels were 15.64 ± 2.9, 25.27 ± 2.7, and 34.7 ng/mL, respectively. Parathyroid hormone (PTH) and bone alkaline phosphatase (BAP) were higher in deficiency (57.65 ± 22.6 ng/mL; 29.5 ± 14 U/L) and in insufficiency (45.88 ± 19.8 ng/mL; 23.47 ± 8.8 U/L) compared with sufficiency of 25OHD (47.13 ± 16 and 22.14± 9.7 ng/mL) (p = 0.062 and p = 0.0440, respectively). TBS was lower in patients with 25OHD < 20 ng/mL (1.24 ± 0.13) compared with between 20–29 (1.27 ± 0.13, p < 0.05) and 30 ng/mL (1.31 ± 0.11, p < 0.01). We found low TBS in patients with PTC and long-term follow-up associated with low serum 25OHD levels, not associated with cancer stage, or accumulative iodine radioactive dose. Low 25OHD associated with deleterious bone quality in patients with PTC should be restored for the prevention of fractures.

scholarly journals TBS Predict Coronary Artery Calcification in Adults

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Tzyy-Ling Chuang ◽  
Fu-Tsung Hsiao ◽  
Yi-Da Li ◽  
Yuh-Feng Wang
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Odds Ratio ◽  
Multinomial Logistic Regression ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Mineral Density ◽  
Unadjusted Odds Ratio ◽  
Group 2 ◽  
Group 1

Purpose. This study analyzes the association between the bony microarchitecture score (trabecular bone score, TBS) and coronary artery calcification (CAC) in adults undergoing health exams.Materials and Methods. We retrospectively collected subjects (N=81) who underwent coronary computed tomography and bone mineral density studies simultaneously. CAC was categorized to three levels (Group 0, G0, no CAC, score = 0,N=45; Group 1, G1, moderate CAC, score = 1–100,N=17; Group 2, G2, high CAC, score≧101,N=19). Multinomial logistic regression was used to study the association between TBS and CAC levels.Results. CAC is present in 44.4% of the population. Mean TBS ± SD was1.399±0.090. Per 1 SD increase in TBS, the unadjusted odds ratio (2.393) of moderate CAC compared with no CAC was significantly increased (95% CI, 1.219–4.696,p=0.011). However, there has been no association of TBS with high CAC (OR: 1.026, 95% CI: 0.586–1.797,p=0.928). These relationships also existed when individually adjusted for age, sex, and multiple other covariates.Conclusions. Higher TBS was related to moderate CAC, but not high CAC; a possible explanation may be that bone microarchitecture remodeling becomes more active when early coronary artery calcification occurs. However, further researches are needed to clarify this pathophysiology.

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