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.

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 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.

scholarly journals Bone mineral density and microarchitecture among Chinese patients with rheumatoid arthritis: a cross-sectional study with HRpQCT

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shangyi Jin ◽  
Mengtao Li ◽  
Qian Wang ◽  
Xiaofeng Zeng ◽  
Weibo Xia ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Bone Mineral ◽  
Bone Microarchitecture ◽  
Fragility Fractures ◽  
Cross Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
X Ray ◽  
Increased Risk

Abstract Background Patients with rheumatoid arthritis (RA) are at increased risk of fractures. Although their decline in bone mineral density (BMD) is well-established, data regarding the alterations in bone microarchitecture are limited. In this study, we aimed to evaluate bone microarchitecture, geometry, and volumetric BMD among patients with RA in mainland China using high-resolution peripheral quantitative computed tomography (HRpQCT). Methods In this cross-sectional study, patients with RA were recruited from the Peking Union Medical College Hospital site of the Chinese Registry of rhEumatoiD arthrITis (CREDIT). Each participant underwent HRpQCT scanning (Scanco XtremeCT II), thoracolumbar X-ray and dual-energy X-ray absorptiometry. The primary outcomes were HRpQCT-related measures at distal radius and tibia. Data regarding demographic features, RA-related characteristics, and history of fragility fractures were collected. Correlation between HRpQCT parameters and potentially related factors were analyzed using linear regression analysis. A group of age- and sex-matched healthy controls was included for comparison. Results A total of 81 patients with RA [69 women, aged 57.9 ± 8.7 years, disease duration 5.7 (IQR 1.4–11.2) years] and 81 matched healthy controls were included. Compared with controls, patients with RA had significantly larger bone area and lower total and trabecular vBMD at both the distal radius and tibia. Lower cortical bone thickness was also shown at the distal tibia. Among patients with RA, advanced age, low BMI, female sex, disease duration, and activity were associated with decreased vBMD and impaired bone microstructure. Female reproductive factors including menopause, late menarche, breast feeding, and early childbirth also showed negative correlation with these parameters. Compared to patients with RA without fractures, patients with fragility fractures (n = 11) showed lower trabecular and cortical vBMD, thinner cortical bone, impaired trabecular microstructure, and a trend of declined bone strength. Current glucocorticoid intake was related to decreased vBMD, trabecular number, increased trabecular separation, and inhomogeneity. Conclusions In this study, we observed alterations in bone mineral density, geometry, and microarchitecture among patients with RA compared to healthy individuals, which may impair bone strength and lead to increased risk of fractures. Both traditional risk factors for osteoporosis and RA-associated factors need to be considered in the assessment of the bone quality.

scholarly journals Low trabecular bone score is associated with high C-reactive protein levels in systemic sclerosis

2021 ◽  
Author(s):  
Kyung-Ann Lee ◽  
JongSun Kim ◽  
Wonho Choi ◽  
Hyun-joo Kim ◽  
Hyun-Sook Kim
Keyword(s):  
Risk Factors ◽  
Systemic Sclerosis ◽  
Lumbar Spine ◽  
Trabecular Bone ◽  
Trabecular Bone Score ◽  
Organ Involvement ◽  
Multivariate Linear Regression Analysis ◽  
C Reactive Protein ◽  
Mineral Density ◽  
Reactive Protein

Abstract Objectives To evaluate trabecular bone score (TBS) in patients with systemic sclerosis (SSc) and to identify risk factors related to low TBS in SSc. Methods TBS and areal bone mineral density (aBMD) were assessed in patients with SSc (n = 57), rheumatoid arthritis (RA) (n = 47), and hand osteoarthritis (OA) (n = 37) using DXA. Osteoporosis risk factors, laboratory findings, SSc-specific organ involvement, and patterns of nailfold capillaroscopy (NFC) were also assessed. Multivariate linear regression analysis was performed to identify the risk factors associated with TBS in SSc patients. Results The median TBS (Q1, Q3) value was 1.378 (1.322, 1.425) in SSc patients, 1.336 (1.261, 1.396) for RA patients, and 1.430 (1.387, 1.438) for controls (p < 0.001). No significant differences were observed in the median lumbar spine TBS and aBMD at the lumbar spine, femoral neck, and total hip between the SSc and RA groups. The TBS was negatively correlated with the erythrocyte sedimentation rate (p = 0.042) and C-reactive protein (CRP) (p = 0.005) in the SSc group only and with cumulative glucocorticoid doses in the RA group only (p = 0.031). We found no association between TBS and SSc cutaneous subtype, internal organ involvement, autoantibody profile, NFC patterns, and use of immunosuppressive agents, such as cyclophosphamide. In the multivariate analyses, age, female sex, current, and average CRP were significantly associated with TBS. Conclusions TBS assessment revealed poor bone quality in patients with SSc, similar to those with RA. CRP levels were negatively correlated with TBS in patients with SSc, and higher CRP levels were independently associated with low TBS.

scholarly journals Bone Microarchitectural Changes in Hyperthyroid Women Compared to a Normal Canadian Cohort

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A256-A257
Author(s):  
Terra G Arnason ◽  
David Cooper ◽  
Reza Behdani ◽  
Saija Kontulainen
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Bone Microarchitecture ◽  
Critical Role ◽  
Primary Objective ◽  
Mineral Density ◽  
Tsh Suppression ◽  
Increased Risk

Abstract Thyroid hormones play a critical role in bone physiology during childhood, but also impacts adult bone metabolism. Hyperthyroidism promotes accelerated bone turnover and bone remodelling which is associated with net loss of bone mineral density over time (BMD) and these changes have been quantitated using the gold standard of measuring BMD, Dual Energy X-ray Absorptiometry (DEXA). Ordinarily, biochemical thyroid hormone normalization restores BMD towards normal, yet an increased risk of fractures remains lifelong. DEXA, therefore, cannot explain the underlying etiology for fracture risk which may be due to undetected changes in bone microarchitecture. Our primary objective was to utilize an investigational 3-dimensional bone imaging technology, High Resolution peripheral Quantitative Tomography (HR-pQCT), to study bone microarchitecture in actively hyperthyroid women to determine if there are changes in cortical and trabecular bone microarchitecture from that of age-matched controls. A subset of women were rescanned using HR-pCT after thyroid hormones had been normalized for at least 6 months to determine if there were cortical/trabecular architectural changes that reversed towards normal in these individual cases. We enrolled 20 hyperthyroid women (age 20–76) for this pilot study who had persistent TSH suppression for &gt;3 months (TSH&lt; 0.5, normal range: 0.5–4.49 mU/L) without secondary causes for bone loss. Their etiology was divided amongst TSH suppression for thyroid carcinoma, Grave’s disease and iatrogenic hyperthyroidism. HR-pQCT scans of the radius were compared to age-matched scans of normal females, available from the robust Canadian Multicentre Osteoporosis Study (CaMOS) control cohort. Four participants were re-scanned after 6 months of TSH normalization to assess reversibility. The observed data showed statistically significant differences in key parameters of bone microarchitecture in hyperthyroidism, independent of etiology. We observed decreased cortical thickness and increased failure load as statistically different from age-matched controls. Increases in cortical bone porosity and decreases in volumetric bone density (cortical, trabecular and total) were notable but did not reach significance in this small study. Repeat scans following normalization of thyroid hormone levels revealed consistent (partial, nonsignificant) normalization of multiple bone microarchitecture elements including increased trabecular number/thickness, and decreased cortical porosity. These findings suggest that there are changes in both cortical and trabecular bone during active hyperthyroidism that may contribute to increased lifelong fracture risk.

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