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Goel H, Binkley N, Boggild M, Chan WP, Leslie WD, McCloskey E, Morgan SL, Silva BC, Cheung AM. Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions. J Clin Densitom 2024; 27:101452. [PMID: 38228014 DOI: 10.1016/j.jocd.2023.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Osteoporosis can currently be diagnosed by applying the WHO classification to bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA). However, skeletal factors other than BMD contribute to bone strength and fracture risk. Lumbar spine TBS, a grey-level texture measure which is derived from DXA images has been extensively studied, enhances fracture prediction independent of BMD and can be used to adjust fracture probability from FRAX® to improve risk stratification. The purpose of this International Society for Clinical Densitometry task force was to review the existing evidence and develop recommendations to assist clinicians regarding when and how to perform, report and utilize TBS. Our review concluded that TBS is most likely to alter clinical management in patients aged ≥ 40 years who are close to the pharmacologic intervention threshold by FRAX. The TBS value from L1-L4 vertebral levels, without vertebral exclusions, should be used to calculate adjusted FRAX probabilities. L1-L4 vertebral levels can be used in the presence of degenerative changes and lumbar compression fractures. It is recommended not to report TBS if extreme structural or pathological artifacts are present. Monitoring and reporting TBS change is unlikely to be helpful with the current version of the TBS algorithm. The next version of TBS software will include an adjustment based upon directly measured tissue thickness. This is expected to improve performance and address some of the technical factors that affect the current algorithm which may require modifications to these Official Positions as experience is acquired with this new algorithm.
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Affiliation(s)
| | - Neil Binkley
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Miranda Boggild
- University of Toronto, Department of Medicine, Toronto, Canada
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; and Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Sarah L Morgan
- University of Alabama at Birmingham, Osteoporosis Prevention and Treatment Clinic and DXA Facility, Birmingham, AL, United States
| | - Barbara C Silva
- Medical School, Centro Universitario de Belo Horizonte (UniBH), MG, Brazil Bone Metabolic diseases Unit, Santa Casa Hospital, Belo Horizonte, MG, Brazil Clinic of Endocrinology, Felicio Rocho Hospital, Belo Horizonte, MG, Brazil
| | - Angela M Cheung
- Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada; Osteoporosis Program, University Health Network and Sinai Health System, Toronto, Ontario, Canada
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Stokar J, Ben-Porat T, Kaluti D, Abu-Gazala M, Weiss R, Mintz Y, Elazari R, Szalat A. Trabecular Bone Score Preceding and during a 2-Year Follow-Up after Sleeve Gastrectomy: Pitfalls and New Insights. Nutrients 2023; 15:3481. [PMID: 37571418 PMCID: PMC10421136 DOI: 10.3390/nu15153481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Bariatric surgery (BS) can have negative effects on bone health. Bone microarchitecture quality evaluation using the trabecular bone score (TBS) has not been described in patients after sleeve gastrectomy (SG). To test the hypothesis that the TBS is clinically useful for this population, we evaluated changes in bone mineral density (BMD) and the TBS in a longitudinal cohort study following SG. The measurements before surgery and after 12 and 24 postoperative months were as follows: weight, height, BMI, waist circumference (WC), BMD and TBS. The results at baseline showed the following: a mean BMI of 43 ± 0.56, TBS of 1.25 ± 0.02, lumbar spine BMD T-score of -0.4 ± 0.93, TBS T-score of -2.30 ± 0.21, significantly lower than BMD-T-score, and associated with a BMD-T-TBS-T gap (T-gap) of -2.05 ± 1.26 (-0.24 ± 0.13). One year after surgery, the TBS had significantly improved (+12.12% ± 1.5), leading to a T-gap of -0.296 ± 0.14, which remained stable at 2 years post-surgery. A correlation analysis revealed a significant negative correlation between the T-gap and WC (r = -0.43 p = 0.004). Our interpretation is that abdominal fat may interfere with image acquisition via increased tissue thickness, leading to a false low TBS at baseline. In conclusion, TBS should be interpreted with caution in patients with obesity and elevated WC. Additionally, we show that after SG, the LS microarchitecture measured using the TBS is partially degraded in up to 25% of patients. Further studies are warranted to assess hip bone microarchitecture changes after bariatric surgery.
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Affiliation(s)
- Joshua Stokar
- Osteoporosis Center, Endocrinology and Metabolism Service, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel
| | - Tair Ben-Porat
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem 9124001, Israel; (T.B.-P.); (D.K.)
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem 9124001, Israel
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Donia Kaluti
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem 9124001, Israel; (T.B.-P.); (D.K.)
| | - Mahmud Abu-Gazala
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel; (M.A.-G.); (Y.M.); (R.E.)
| | - Ram Weiss
- Department of Pediatrics, Rambam Medical Center, Technion School of Medicine, Haifa 3200003, Israel;
| | - Yoav Mintz
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel; (M.A.-G.); (Y.M.); (R.E.)
| | - Ram Elazari
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel; (M.A.-G.); (Y.M.); (R.E.)
| | - Auryan Szalat
- Osteoporosis Center, Endocrinology and Metabolism Service, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel
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Leslie WD, Goel H, Binkley N, McCloskey EV, Hans D. Contributions of Clinical and Technical Factors to Longitudinal Change in Trabecular Bone Score and Bone Density: A Registry-Based Individual-Level Analysis. J Bone Miner Res 2023; 38:512-521. [PMID: 36655775 DOI: 10.1002/jbmr.4774] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Abstract
Lumbar spine trabecular bone score (TBS), a gray-level texture measure derived from spine dual-energy X-ray absorptiometry (DXA) images, is a bone mineral density (BMD)-independent risk factor for fracture. An unresolved question is whether TBS is sufficiently responsive to change over time or in response to widely used osteoporosis therapy at the individual level to serve as a useful biomarker. Using the Manitoba DXA Registry, we identified 11,643 individuals age 40 years and older with two fan-beam DXA scans performed on the same instrument within 5 years (mean interval 3.2 years), of whom 6985 (60.0%) received antiresorptive osteoporosis medication (majority oral bisphosphonate) between the scans. We examined factors that were associated with a change in lumbar spine TBS, lumbar spine BMD, and total hip BMD exceeding the 95% least significant change (LSC). Change exceeding the LSC was identified in 23.0% (9.3% increase, 13.8% decrease) of lumbar spine TBS, 38.2% (22.1% increase, 16.1% decrease) lumbar spine BMD, and 42.5% (17.6% increase, 24.9% decrease) total hip BMD measurement pairs. From regression models, the variables most strongly associated with significant change in TBS (decreasing order) were tissue thickness change, acquisition mode change, weight change, and spine percent fat change. Consistent with the insensitivity of TBS to oral antiresorptive therapies, use of these agents showed very little effect on TBS change. In contrast, for both spine BMD change and total hip BMD change, osteoporosis medication use was the most significant variable, whereas tissue thickness change, acquisition mode change, and weight change had relatively weak effects. In summary, change in spine TBS using the present algorithm appears to be strongly affected by technical factors. This suggests a limited role, if any, for using TBS change in untreated individuals or for monitoring response to antiresorptive treatment in routine clinical practice with the current version of the TBS algorithm. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Neil Binkley
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Didier Hans
- Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
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Leslie WD, Binkley N, Hans D. Ethnicity and Fracture Risk Stratification from Trabecular Bone Score in Canadian Women: The Manitoba BMD Registry. J Clin Densitom 2023; 26:83-89. [PMID: 36509619 DOI: 10.1016/j.jocd.2022.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Lumbar spine Trabecular Bone Score (TBS), a grey-level texture measure derived from spine dual-energy x-ray absorptiometry (DXA) images, is a bone mineral density (BMD)-independent risk factor for fracture. An unresolved and controversial question is whether there are ethnic differences that affect the utility of TBS for fracture risk assessment. The current analysis examined whether self-identified ethnicity (White, Asian, Black) in women age 40 years and older referred for DXA testing affected fracture risk stratification from TBS using a large clinical registry. The study population comprised 63,078 White women, 1,915 Asian women and 329 Black women (n=329) with mean follow up 9.0±5.2 years. There were between group differences in BMI (Black>White>Asian), lumbar spine fat percentage (Asian>White>Black) and lumbar spine tissue thickness (Black>White>Asian). Despite this, lumbar spine TBS was not significantly different between the subgroups, though there was a significant difference in lumbar spine and total hip BMD (Black >White>Asian). TBS provided significant stratification for MOF and any fracture for all ethnicity subgroups, and for hip fracture in White and Asian subgroups (insufficient numbers for analysis in Black women). No significant difference in White vs. Asian or White vs. Black women were identified using a Bonferroni adjusted p-value. In summary, we found that lumbar spine TBS measurements were similar among White, Asian and Black women referred for DXA assessment in Manitoba, Canada. TBS and BMD measurements significantly stratified fracture risk in all three populations without a meaningful difference between groups. This suggests that TBS does not need to be used differently in White vs. non-White populations.
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Affiliation(s)
- William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada..
| | - Neil Binkley
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Didier Hans
- Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
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Leslie WD, Hans D. Trabecular Bone Score (TBS) Cross-Calibration for GE Prodigy and IDXA Scanners. J Clin Densitom 2023; 26:56-60. [PMID: 36509618 DOI: 10.1016/j.jocd.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) is used for osteoporosis diagnosis, fracture prediction and to monitor changes in bone mineral density (BMD). Change in DXA instrumentation requires formal cross-calibration and procedures have been described by the International Society for Clinical Densitometry. Whether procedures used for BMD cross-calibration are sufficient to ensure lumbar spine trabecular bone score (TBS) cross-calibration is currently uncertain. The Manitoba Bone Density Program underwent a program-wide upgrade in DXA instrumentation from GE Prodigy to iDXA in 2012, and a representative a sample of 108 clinic patients were scanned on both instruments. Lumbar spine TBS (L1-L4) measurements were retrospectively derived in 2013. TBS calibration phantoms were not available at our site when this was performed. We found excellent agreement for lumbar spine BMD, without deviation from the line of perfect agreement, and low random error (standard error of the estimate [SEE] 2.54% of the mean). In contrast, spine TBS (L1-L4) showed significant deviation from the line of identity: TBS(iDXA) = 0.730 x TBS(Prodigy) + 0.372 (p<0.001 for slope and intercept); SEE 5.12% of the mean with negative bias (r=-0.550). Results were worse for scans acquired in thick versus standard mode, but similar when the population was stratified as BMI < or > 35 kg/m2. In summary, it cannot be assumed that just because BMD cross-calibration is good that this applies to TBS. This supports the need for using TBS phantom calibration to accommodate between-scanner differences as part of the manufacturer's TBS software installation.
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Affiliation(s)
- William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Didier Hans
- Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
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Binkley N, Krueger D, Leslie WD. Accurate Weight and Height Measurement is Essential for Correct Trabecular Bone Score Determination. J Clin Densitom 2023; 26:52-54. [PMID: 36470791 DOI: 10.1016/j.jocd.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Neil Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, Madison WI, United States
| | - Diane Krueger
- University of Wisconsin Osteoporosis Clinical Research Program, Madison WI, United States
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Chuang TL, Chuang MH, Wang YF, Koo M. Comparison of Trabecular Bone Score-Adjusted Fracture Risk Assessment (TBS-FRAX) and FRAX Tools for Identification of High Fracture Risk among Taiwanese Adults Aged 50 to 90 Years with or without Prediabetes and Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121766. [PMID: 36556968 PMCID: PMC9787568 DOI: 10.3390/medicina58121766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Background and Objectives: The burden of osteoporosis is projected to increase. Identification and prompt intervention for osteoporotic fractures are important. Adjusting the Fracture Risk Assessment (FRAX®) tool with trabecular bone score (TBS) could improve risk prediction. However, little is known about whether TBS-adjusted FRAX® would change the proportion of individuals qualified for osteoporosis intervention. Therefore, the aim of the present study was to compare the proportions of Taiwanese adults who qualified for intervention, according to the FRAX® and TBS-adjusted FRAX®, with stratification by sex, age group, and glucose regulation status. Materials and Methods: A medical record review on adults 50−90 years who had undergone a general health examination in a regional hospital in Taiwan was conducted. FRAX® and TBS-adjusted FRAX® were calculated. FRAX® cut-points of ≥ 20% for major osteoporotic fracture and ≥3% for hip fracture were adopted to identify individuals qualified for osteoporosis intervention. Individuals were classified as prediabetes and diabetes if their HbA1c was 5.7−6.4% and >6.4%, respectively. Results: A total of 8098 individuals with a mean age of 61.0 years were included. The proportion of men qualified for intervention for hip fracture was significantly lower according to TBS-adjusted FRAX® (17.2%) compared with FRAX® (20.7%) (p < 0.001), with a similar pattern across all three age groups and in those with prediabetes. In contrast, the proportion of women qualified for intervention for major osteoporotic fracture was significantly higher according to TBS-adjusted FRAX® (4.6%) compared with FRAX® (3.7%) (p < 0.001), particularly among those with prediabetes 60−69 years. Conclusions: TBS-adjusted FRAX® led to small but significant changes in the proportions of individuals qualified for intervention in specific age groups and glucose regulation status.
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Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622401, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
| | - Mei-Hua Chuang
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
- Faculty of Pharmacy, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City 11260, Taiwan
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei 112021, Taiwan
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu 300102, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien 970302, Taiwan
- Correspondence: ; Tel.: +886-3-857-2158 (ext. 2206)
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Liu J, Tang J, Xia B, Gu Z, Yin H, Zhang H, Yang H, Song B. Novel Radiomics-Clinical Model for the Noninvasive Prediction of New Fractures After Vertebral Augmentation. Acad Radiol 2022; 30:1092-1100. [PMID: 35915030 DOI: 10.1016/j.acra.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the noninvasive prediction model for new fractures after percutaneous vertebral augmentation (PVA) based on radiomics signature and clinical parameters. METHODS Data from patients who were diagnosed with osteoporotic vertebral compression fracture (OVCF) and treated with PVA in our hospital between May 2014 and April 2019 were retrospectively analyzed. Radiomics features were extracted from T1-weighted magnetic resonance imaging (MRI) of the T11-L5 segments taken before PVA. Different radiomics models was developed by using linear discriminant analysis (LDA), multilayer perceptron (MLP), and stochastic gradient descent (SGD) classifiers. A nomogram was constructed by integrating clinical parameters and Radscore that calculated by the best radiomics model. The model performance was quantified in terms of discrimination, calibration and clinical usefulness. RESULT Four clinical parameters and 16 selected radiomics features were used for model development. The clinical model showed poor discrimination capability with area under the curves (AUCs) yielding of 0.522 in the training dataset and 0.517 in the validation dataset. The LDA, MLP and SGD classifier-based radiomics model had achieved AUCs of 0.793, 0.810, and 0.797 in the training dataset, and 0.719, 0.704, and 0.725 in the validation dataset, respectively. The nomogram showed the best performance with AUCs achieving 0.810 and 0.754 in the training and validation datasets, respectively. The decision curve analysis demonstrated the net benefit of the nomogram was higher than that of other models. CONCLUSION Our findings indicate that combining clinical features with radiomics features from pre-augmentation T1-weighted MRI can be used to develop a nomogram that can predict new fractures in patients after PVA.
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Shieh A, Greendale GA, Cauley JA, Karvonen-Gutierriez C, Harlow SD, Finkelstein JS, Liao D, Huang MH, Karlamangla AS. Prediabetes and insulin resistance are associated with lower trabecular bone score (TBS): cross-sectional results from the Study of Women's Health Across the Nation TBS Study. Osteoporos Int 2022; 33:1365-1372. [PMID: 35178609 PMCID: PMC9106606 DOI: 10.1007/s00198-022-06325-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/26/2022] [Indexed: 12/04/2022]
Abstract
In pre- and early perimenopausal women, prediabetes (with blood glucose ≥ 110 mg/dL) and greater insulin resistance are associated with worse trabecular bone quality (as assessed by trabecular bone score). PURPOSE Diabetes mellitus (DM) is associated with lower trabecular bone score (TBS) and fracture; less certain is whether the precursor states of prediabetes and increased insulin resistance are also related to adverse bone outcomes. We examined, in women who do not have DM, the associations of glycemic status (prediabetes vs. normal) and insulin resistance with TBS. METHODS This was a cross-sectional analysis of baseline data collected from 42- to 52-year-old, pre- and perimenopausal participants in the Study of Women's Health Across the Nation (SWAN) TBS Study. Women with prediabetes were categorized as having either high prediabetes if their fasting glucose was between 110 and 125 mg/dL or low prediabetes if their fasting glucose was between 100 and 109 mg/dL. Normoglycemia was defined as a fasting glucose below 100 mg/dL. RESULTS In multivariable linear regression, adjusted for age, race/ethnicity, menopause transition stage, cigarette use, calcium and vitamin D supplementation, lumbar spine bone mineral density, and study site, women with high prediabetes had 0.21 (p < 0.0001) standard deviations (SD) lower TBS than those with normoglycemia. Low prediabetes was not associated with lower TBS. When HOMA-IR levels were ≥ 1.62, each doubling of HOMA-IR was associated with a 0.11 SD decrement in TBS (p = 0.0001). CONCLUSION Similar to diabetics, high prediabetics have lower TBS than normoglycemic individuals. Women with greater insulin resistance have lower TBS even in the absence of DM. Future studies should examine the associations of high prediabetes and insulin resistance with incident fracture.
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Affiliation(s)
- Albert Shieh
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
| | - Gail A Greendale
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | | | - Sioban D Harlow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joel S Finkelstein
- Division of Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana Liao
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Mei-Hua Huang
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Arun S Karlamangla
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
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Jain RK, Vokes T. Comment on article "Race/ethnic difference in trabecular bone score in midlife women: The Study of Women's Health Across the Nation (SWAN)". Osteoporos Int 2022; 33:949-950. [PMID: 35075498 DOI: 10.1007/s00198-021-06248-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Rajesh K Jain
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, IL, 60637, USA.
| | - Tamara Vokes
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, IL, 60637, USA
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Palomo T, Dreyer P, Muszkat P, Weiler FG, Bonansea TCP, Domingues FC, Vieira JGH, Silva BC, Brandão CMA. Effect of soft tissue noise on trabecular bone score in postmenopausal women with diabetes: A cross sectional study. Bone 2022; 157:116339. [PMID: 35051679 DOI: 10.1016/j.bone.2022.116339] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is associated with increased fracture risk, despite similar or greater BMD compared to nondiabetics. TBS predicts fracture risk in T2D and nondiabetics. However, increased abdominal thickness, a common feature in T2D, may reduce TBS values. AIM To study the relationship among glycemic status, BMD and TBS, considering abdominal soft tissue thickness (STT) interference. METHODS Cross-sectional analysis of 493 women ≥65 years, with simultaneous DXA scans and HbA1c measures. STT and TBS (iNsight Software, v3.0) were derived from lumbar spine (LS) scans. Subjects were divided according to HbA1c levels: 1 (≥6.5%; n = 116), 2 (5.7-6.4%; n = 217) and 3 (≤5.6%; n = 160). Group 1 was further divided based on HbA1c and/or disease duration: 1a (HbA1c ≥ 7.5%; n = 42), 1b (HbA1c ≥ 6.5% and disease duration ≥5 years; n = 63) and 1c (HbA1c ≥ 7.5% and disease duration ≥5 years; n = 30). FINDINGS For the entire cohort, mean age, TBS, BMI and STT were 71.8 ± 6.0 years, 1.299 ± 0.101, 26.9 ± 4.1 kg/m2, and 21.4 ± 2.9 cm, respectively. LS-BMD was similar among groups. BMD in hip sites and STT were higher in group 1. TBS was lower in patients with higher HbA1c (P = 0.020), with a mean TBS in groups 1, 2, and 3 of 1.280, 1.299 and 1.314, respectively. This difference remained after adjusting for age, LS-BMD and BMI (P = 0.010). After replacing BMI with STT, TBS differences were no longer significant (P = 0.270). The same was observed when subgroups 1a and 1b were compared to group 3. However, for subgroup 1c, TBS remained lower compared to group 3, even after adjusting for age, LS-BMD and STT, with a borderline P-value (1.275 vs. 1.308; P = 0.047). CONCLUSION Higher HbA1c levels were associated with greater BMD in hip sites, higher abdominal STT and lower TBS values. However, after including the STT in the adjustment, TBS differences among groups disappeared, except in women with higher HbA1c levels and longer disease duration.
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Affiliation(s)
- Telma Palomo
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil.
| | - Patricia Dreyer
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | - Patricia Muszkat
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | - Fernanda G Weiler
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | - Teresa C P Bonansea
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | | | - Jose G H Vieira
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil; Department of Medicine, Endocrinology Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Barbara C Silva
- Endocrinology Unit, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil; Endocrinology Unit, Felicio Rocho Hospital, Belo Horizonte, Brazil; Department of Medicine, Centro Universitario de Belo Horizonte (UNI-BH), Belo Horizonte, Brazil
| | - Cynthia M A Brandão
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
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Kalkwarf HJ, Shepherd JA, Hans D, Gonzalez Rodriguez E, Kindler JM, Lappe JM, Oberfield S, Winer KK, Zemel BS. Trabecular Bone Score Reference Values for Children and Adolescents According to Age, Sex, and Ancestry. J Bone Miner Res 2022; 37:776-785. [PMID: 35118727 PMCID: PMC9018558 DOI: 10.1002/jbmr.4520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
Trabecular bone score (TBS) is used for fracture prediction in adults, but its utility in children is limited by absence of appropriate reference values. We aimed to develop reference ranges for TBS by age, sex, and population ancestry for youth ages 5 to 20 years. We also investigated the association between height, body mass index (BMI), and TBS, agreement between TBS and lumbar spine areal bone mineral density (aBMD) and bone mineral apparent density (BMAD) Z-scores, tracking of TBS Z-scores over time, and precision of TBS measurements. We performed secondary analysis of spine dual-energy X-ray absorptiometry (DXA) scans from the Bone Mineral Density in Childhood Study (BMDCS), a mixed longitudinal cohort of healthy children (n = 2014) evaluated at five US centers. TBS was derived using a dedicated TBS algorithm accounting for tissue thickness rather than BMI. TBS increased only during ages corresponding to pubertal development with an earlier increase in females than males. There were no differences in TBS between African Americans and non-African Americans. We provide sex-specific TBS reference ranges and LMS values for calculation of TBS Z-scores by age and means and SD for calculation of Z-scores by pubertal stage. TBS Z-scores were positively associated with height Z-scores at some ages. TBS Z-scores explained only 27% and 17% of the variance of spine aBMD and BMAD Z-scores. Tracking of TBS Z-scores over 6 years was lower (r = 0.47) than for aBMD or BMAD Z-scores (r = 0.74 to 0.79), and precision error of TBS (2.87%) was greater than for aBMD (0.85%) and BMAD (1.22%). In sum, TBS Z-scores provide information distinct from spine aBMD and BMAD Z-scores. Our robust reference ranges for TBS in a well-characterized pediatric cohort and precision error estimates provide essential tools for clinical assessment using TBS and determination of its value in predicting bone fragility in childhood and adolescence. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Didier Hans
- Interdisciplinary Center for Bone Diseases, Bone and Joint Department, Lausanne University and Lausanne University Hospital, Lausanne, Switzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center for Bone Diseases, Bone and Joint Department, Lausanne University and Lausanne University Hospital, Lausanne, Switzerland
| | - Joseph M Kindler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Joan M Lappe
- Department of Medicine, Creighton University, Omaha, NE, USA
| | - Sharon Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Richards C, Leslie WD. Trabecular Bone Score in Rheumatic Disease. Curr Rheumatol Rep 2022; 24:81-87. [PMID: 35334058 DOI: 10.1007/s11926-022-01062-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Patients with rheumatic disease are at high risk of low bone mass and osteoporotic fracture. Trabecular bone score (TBS), derived from lumbar spine dual-energy x-ray absorptiometry (DXA), is a novel measure of bone texture that independently predicts fracture risk. This review examines the role of TBS in rheumatic disease including fracture prediction. RECENT FINDINGS Most studies concerning TBS and rheumatic disease are cross-sectional, with consistent evidence of lower TBS in patients with rheumatic disease compared to controls. Recent studies have shown association and predictive ability of TBS for prevalent fracture, and the few longitudinal studies showed predictive ability of TBS for incident fracture. TBS in ankylosing spondylitis is of interest given the high rates of vertebral fracture and technical difficulty with lumbar spine bone mineral density. TBS degradation has been associated with disease activity in ankylosing spondylitis, systemic sclerosis, and rheumatoid arthritis. Glucocorticoid exposure is associated with lower TBS, and predicts prevalent fracture, in patients with rheumatic conditions.
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Affiliation(s)
- Ceri Richards
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. .,Department of Rheumatology, University of Manitoba, RR149 800 Sherbrook Street, Winnipeg, MB, R3A 1M4, Canada.
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, R2H 2A6, Canada
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14
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Body Composition as a Modulator of Bone Health Changes in Patients with Inflammatory Bowel Disease. Life (Basel) 2022; 12:life12020272. [PMID: 35207559 PMCID: PMC8875340 DOI: 10.3390/life12020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Bone impairment of multifactorial etiology is a common feature in inflammatory bowel disease (IBD). Body composition parameters, which might be selectively modified in these patients, are important determinants of bone strength. Our aim was to investigate the relationship between components of body composition and bone parameters in IBD patients. Methods: This is a cross-sectional, retrospective study including 80 IBD patients (43 women, 37 men). Lumbar spine (LS), femoral neck (FN) and whole body DXA scans were performed to analyze regional bone mineral density (BMD), as well as body composition, including appendicular skeletal muscle mass index (ASMI), total and visceral fat mass (VAT). Trabecular bone score (TBS) was assessed using iNsight Software. Results: Twenty (25%) IBD patients had inadequate LS-BMD z scores (<=−2DS). Lean mass (LM) was a significant determinant of LS-BMD, after adjusting for age, gender, BMI and fat mass (p < 0.01), while fat mass% remained associated with FN-BMD (p < 0.01). TBS correlated positively with BMI (r = 0.24, p < 0.05), LS-BMD (r = 0.56, p < 0.001), ASMI (r = 0.34, p < 0.001) and negatively with VAT/total fat% (r = −0.27, p < 0.05). Multivariate analysis showed that ASMI, LS-BMD (positively) and VAT/total fat% (negatively) were independently associated with TBS. Conclusions: In IBD patients, skeletal muscle mass and fat percentage and distribution are important factors associated with bone health.
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15
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Ran B, Wei F, Gong J, Xu H. Application and prospect of trabecular bone score in differentiated thyroid cancer patients receiving thyrotropin suppression therapy. Front Endocrinol (Lausanne) 2022; 13:1004962. [PMID: 36313757 PMCID: PMC9596913 DOI: 10.3389/fendo.2022.1004962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Thyroid-stimulating hormone (TSH) suppression therapy is one of the common treatments for most patients with differentiated thyroid cancer (DTC). Unfortunately, its detrimental effects on bone health are receiving increasing attention. It may increase the risk of osteoporosis and osteoporotic fractures. The trabecular bone score (TBS) is a relatively new gray-scale texture measurement parameter that reflects bone microarchitecture and bone strength and has been shown to independently predict fracture risk. We reviewed for the first time the scientific literature on the use of TBS in DTC patients on TSH suppression therapy and aim to analyze and compare the utility of TBS with bone mass strength (BMD) in the management of skeletal health and prediction of fracture risk. We screened a total of seven relevant publications, four of which were for postmenopausal female patients and three for all female patients. Overall, postmenopausal female patients with DTC had lower TBS and a significant reduction in TBS after receiving TSH suppression therapy, but their BMD did not appear to change significantly. In addition, TBS was also found to be an independent predictor of osteoporotic fracture risk in postmenopausal women with DTC receiving TSH suppression therapy. However, due to limitations in the number of studies and study populations, this evidence is not sufficient to fully demonstrate the adverse effects of TSH suppression therapy on patients' TBS or BMD and the efficacy of TBS, and subsequent larger and more case-cohort studies are needed to further investigate the relationship and application of TBS to TSH suppression therapy in terms of skeletal health impairment and fracture risk in DTC patients.
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16
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Chuang TL, Chuang MH, Wang YF, Koo M. Age-Specific Normative Values of Lumbar Spine Trabecular Bone Score (TBS) in Taiwanese Men and Women. J Clin Med 2021; 10:jcm10204740. [PMID: 34682863 PMCID: PMC8537042 DOI: 10.3390/jcm10204740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Trabecular bone score (TBS) is a novel method for assessing trabecular microarchitecture. Normative values of TBS are available for various populations of the world but are not yet available for Taiwanese adults. Therefore, the purpose of this study was to estimate age-specific, normative TBS curves for Taiwanese men and women. Medical records of general health examinations from a regional hospital in Southern Taiwan were reviewed. Individuals aged 30–90 years with data on lumbar spine bone mineral density (BMD) were included. TBS was retrospectively calculated from dual-energy X-ray absorptiometry scans using TBS iNsight software. Of the 12,028 patients included, 4533 (37.7%) were male and the mean age was 55.8 years. The mean TBS was 1.392 (standard deviation (SD) 0.089) for men and 1.344 (SD 0.107) for women. In women, TBS declined at a rate of 0.0004/year among those aged 30.0–45.9 years, 0.0106/year among those 46.0–60.7 years, and 0.0028/year among those 60.8–90.0 years. In men, TBS declined at a constant rate of 0.0023/year over the entire age range. In conclusion, age-adjusted, normative curves of TBS for Taiwanese men and women are presented, which could be used to facilitate the use of TBS in assessing bone status in clinical practice.
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Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (T.-L.C.); (Y.-F.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
| | - Mei-Hua Chuang
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Faculty of Pharmacy, National Yang-Ming Chiao Tung University, Taipei City 112304, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, New Taipei City 112021, Taiwan
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (T.-L.C.); (Y.-F.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Center of Preventive Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien 970302, Taiwan
- Correspondence: ; Tel.: +886-3-857-2158 (ext. 2206)
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17
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Panahi N, Ostovar A, Fahimfar N, Aghaei Meybodi HR, Gharibzadeh S, Arjmand B, Sanjari M, Khalagi K, Heshmat R, Nabipour I, Soltani A, Larijani B. Factors associated with TBS worse than BMD in non-osteoporotic elderly population: Bushehr elderly health program. BMC Geriatr 2021; 21:444. [PMID: 34315430 PMCID: PMC8314528 DOI: 10.1186/s12877-021-02375-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/02/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Bone mineral density (BMD) and trabecular bone score (TBS) are moderately correlated. TBS is sometimes used as an adjuvant to BMD in the fracture risk assessment. Some individuals with normal BMD or osteopenia, have more degraded TBS. We aimed to identify factors associated with TBS worse than BMD in the non-osteoporotic elderly population. METHODS The study subjects were selected from 2384 women and men aged ≥60 years participating in the second stage of the Bushehr Elderly Health program, a population-based prospective cohort study in Iran. The BMDs of different sites and the lumbar spine texture were measured using dual-energy X-ray absorptiometry and the TBS algorithm, respectively. Subjects were categorized based on their BMD and TBS status. Logistic regression was performed to identify the factors associated with "TBS worse than BMD" in non-osteoporotic individuals. RESULTS Of 1335 participants included in the study, 112 of 457 women, and 54 of 878 men had worse TBS than BMD. In multivariable analysis, TBS worse than BMD in women was statistically significantly associated with years since menopause (OR: 1.04 (1.00-1.07)) and waist circumference (OR: 1.09 (1.05-1.14)). However, in men, the condition was statistically significantly associated with waist circumference (OR: 1.10 (1.03-1.17)), current smoking (OR: 2.54 (1.10-5.84)), and HDL-C (OR: 1.03 (1.00-1.06)). CONCLUSION The results of the study show that higher waist circumference is associated with more degraded TBS than BMD in both men and women. Years passed since menopause and current smoking, respectively in women and men, were associated with more degraded TBS. Considering TBS values in older individuals with higher waist circumference, or a history of smoking despite normal BMDs might help more accurate assessment of bone health. However, further studies are required to confirm the benefit.
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Affiliation(s)
- Nekoo Panahi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Aghaei Meybodi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoora Gharibzadeh
- Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
| | - Babak Arjmand
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Akbar Soltani
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Bone characteristics and metabolic phenotypes of obesity in an Iranian Elderly population: Bushehr Elderly Health Program (BEHP). Arch Osteoporos 2021; 16:92. [PMID: 34101034 DOI: 10.1007/s11657-021-00953-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/19/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Obesity and osteoporosis are health problems with high impact on the morbidity and mortality rate. While the association between BMI and bone density is known, the combined effects of obesity and metabolic components on bone health have not yet been revealed. The objectives of this study were to determine the association between bone health and different phenotypes of obesity in an elderly population. METHODS This cross-sectional study was conducted on the data collected in the Bushehr Elderly Health Program (BEHP). The participants were classified in four groups based on the metabolic phenotypes of obesity (metabolic healthy obese (MHO), metabolic non-healthy non-obese (MNHNO), metabolic non-healthy obese (MNHO), and metabolic healthy non-obese (MHNO)). The association between osteoporosis and TBS and the metabolic phenotypes of obesity were assessed using multiple variable logistic regression models. RESULTS Totally, 2378 people (1227 women) were considered for analyses. The prevalence of MHNO, MHO, MNHNO, and MNHO were 902 (39.9%), 138 (6.1%), 758 (33.5%), and 464 (20.5%), respectively. In the multivariate logistic regression models, those with MHO (OR 0.22; 95% CI 0.12-0.36), MNHNO (OR 0.52; 95% CI 0.4-0.66), and MNHO phenotypes (OR 0.22; 95% CI 0.16-0.3) had a significantly lower risk of osteoporosis. Likewise, those having MHO (OR 2.38; 95% CI 1.51-3.76), MNHNO (OR 1.49; 95% CI 1.11-2), and MNHO (OR 2.50; 95% CI 1.82-3.42) phenotypes were found to had higher risk of low bone quality as confirmed by TBS. CONCLUSIONS The obese subjects have lower bone quality, regardless of their obesity phenotype.
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19
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Cauley JA, Karlamangla AS, Ruppert K, Lian Y, Huang M, Harlow S, Finkelstein JS, Greendale GA. Race/ethnic difference in trabecular bone score in midlife women: The Study of Women's Health Across the Nation (SWAN). Arch Osteoporos 2021; 16:91. [PMID: 34101033 PMCID: PMC8527525 DOI: 10.1007/s11657-021-00951-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/19/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED There was no difference in Trabecular Bone Score (TBS) comparing White and Black women after adjusting for body mass index (BMI) and diabetes status. Japanese women had lower TBS than White women. Our results diverge from established differences in fracture rates by race/ethnicity. INTRODUCTION The TBS was developed as an indirect measure of vertebral bone microarchitecture derived from texture analysis of lumbar spine DXA scans. There is little information on race/ethnic differences in TBS. METHODS We compared TBS in 656 White, 492 Black, and 268 Japanese pre- and early perimenopausal women. We used a beta version of TBS that accounts for tissue thickness using DXA measured soft tissue thickness rather than BMI. The relation between BMI and tissue thickness corrected TBS differed by BMI; we used a three-segment linear spline to adjust for BMI. RESULTS The women were, on average, 46.5 years of age; 50% were premenopausal. In BMI and diabetes adjusted models, there was no difference in TBS between White and Black women. TBS was modestly (2%) lower in the Japanese women compared to White women, p = 0.04. In a sensitivity analysis, restricting the analysis to those with BMI 24-31 kg/m2, results were similar. CONCLUSIONS TBS was similar in Black and White women after accounting for tissue thickness and adjusting for BMI, diabetes, and other covariates. The Japanese women had modestly lower TBS. These results diverge from established race/ethnic differences in fracture rates and areal bone mineral density, underscoring the need for further studies.
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Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A533, Pittsburgh, PA, 15261, USA.
| | - Arun S Karlamangla
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, USA
| | - Kristine Ruppert
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A533, Pittsburgh, PA, 15261, USA
| | - Yinjuan Lian
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A533, Pittsburgh, PA, 15261, USA
| | - MeiHua Huang
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, USA
| | - Sioban Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joel S Finkelstein
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Gail A Greendale
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, USA
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20
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Kong SH, Hong N, Kim JW, Kim DY, Kim JH. Application of the Trabecular Bone Score in Clinical Practice. J Bone Metab 2021; 28:101-113. [PMID: 34130362 PMCID: PMC8206609 DOI: 10.11005/jbm.2021.28.2.101] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023] Open
Abstract
The trabecular bone score (TBS) was introduced as an indirect index of trabecular microarchitecture, complementary to bone mineral density (BMD), and is derived using the same dual energy X-ray absorptiometry images. Recently, it has been approved for clinical use in Korea. Therefore, we conducted a comprehensive review to optimize the use of TBS in clinical practice. The TBS is an independent predictor of osteoporotic fractures in postmenopausal women and men aged >50 years. The TBS is potentially useful in monitoring the skeletal effects of anabolic agents but not of antiresorptive agents. In postmenopausal women with type 2 diabetes mellitus, the TBS assesses osteoporotic fracture risk not captured by BMD. However, high body mass index and soft tissue thickness can cause underestimation of the TBS; however, this limitation has been improved in recent versions of the TBS software. However, a high precision error and low reproducibility limit the use of TBS. This review may provide information on the application of the TBS in clinical practice based on reliable evidence.
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Affiliation(s)
- Sung Hye Kong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Namki Hong
- Division of Endocrinology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Woo Kim
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Deog Yoon Kim
- Department of Nuclear Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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21
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Chung CW, Choi HS, Kong SH, Park YJ, Park DJ, Ahn HY, Cho SW. Measurements of Bone Health after Thyroid-Stimulating Suppression Therapy in Postmenopausal Women with Differentiated Thyroid Carcinoma: Bone Mineral Density versus the Trabecular Bone Score. J Clin Med 2021; 10:jcm10091964. [PMID: 34063726 PMCID: PMC8125563 DOI: 10.3390/jcm10091964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Thyroid-stimulating hormone (TSH) suppression therapy is an important treatment modality for differentiated thyroid carcinoma (DTC), but it increases fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal DTC patients receiving TSH suppression therapy. Methods: A total of 410 postmenopausal DTC patients who underwent thyroidectomy and had at least two dual-energy X-ray absorptiometry measurements, including a preoperative measurement, were included. Patients who had osteoporosis medication for more than 1 year were classified as ‘patients with osteoporosis’. Results: In patients without osteoporosis, the change in %BMD was similar between TSH suppression (−) and (+) groups, while the decrease in %TBS was significantly greater in the TSH suppression (+) group than that of the TSH suppression (−) group. The relative risk of vertebral fracture was decreased by TBS changes but not by BMD changes. In patients with osteoporosis, both BMD and TBS showed significant increases in the TSH suppression (−) group but not in TSH suppression (+) group. At year 4, TBS was significantly lower in the TSH suppression (+) group than that in the TSH suppression (−) group, while BMD showed no difference between groups. Conclusions: TBS may better reflect bone health than BMD in postmenopausal DTC patients with TSH suppression therapy.
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Affiliation(s)
- Chae Won Chung
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon-si 24289, Korea;
| | - Sung Hye Kong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Department of Internal Medicine, Seoul National University Bundang Hospital, Kyonggi 13620, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea;
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: ; Tel.: +82-2-2072-4761
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22
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Shoji MM, Ingall EM, Rozental TD. Upper Extremity Fragility Fractures. J Hand Surg Am 2021; 46:126-132. [PMID: 32863106 DOI: 10.1016/j.jhsa.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/07/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023]
Abstract
The population of elderly patients is rapidly increasing in the United States and worldwide, leading to an increased prevalence of osteoporosis and a concurrent rise in fragility fractures. Fragility fractures are defined as fractures involving a low-energy mechanism, such as a fall from a standing height or less, and have been associated with a significant increase in the risk of a future fragility fracture. Distal radius fractures in the elderly often present earlier than hip and vertebral fractures and frequently involve underlying abnormalities in bone mass and microarchitecture. This affords a unique opportunity for upper extremity surgeons to aid in the diagnosis and treatment of osteoporosis and the prevention of secondary fractures. This review aims to outline current recommendations for orthopedic surgeons in the evaluation and treatment of upper extremity fragility fractures.
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Affiliation(s)
- Monica M Shoji
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Eitan M Ingall
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Tamara D Rozental
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Greendale GA, Huang M, Cauley JA, Harlow S, Finkelstein JS, Karlamangla AS. Premenopausal and early postmenopausal trabecular bone score (TBS) and fracture risk: Study of Women's Health Across the Nation (SWAN). Bone 2020; 140:115543. [PMID: 32730933 PMCID: PMC7526344 DOI: 10.1016/j.bone.2020.115543] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/03/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evidence that trabecular bone score (TBS), an index of bone microstructure, is a risk factor for future fracture comes mainly from studies of late postmenopausal women. OBJECTIVE To discern whether premenopausal TBS or early postmenopausal TBS predict fracture. DESIGN A 22-year, prospective analysis from the Study of Women's Health Across Nation. SETTING Community-based cohort. PARTICIPANTS 272 Black, 174 Japanese, and 364 White women. MAIN OUTCOME MEASURES Incident fractures: 292 in premenopausal sample and 141 in early postmenopausal sample. RESULTS Separate Cox proportional hazard regressions modeled time to incident fracture as a function of TBS measured during premenopause or early postmenopause. Models were initially adjusted for age, race/ethnicity, SWAN clinical site, body mass index, use of calcium, vitamin D, bone beneficial or bone adverse medication. Next, we added lumbar spine (LS) or femoral neck (FN) bone mineral density (BMD) and, finally, history of prior fracture, to the models. For each standard deviation decrement in premenopausal TBS, fracture hazard was elevated by 17% (relative hazard [RH] 1.17 [95% CI, 1.02-1.35]); after adjusting for LS or FN BMD, the relation between premenopausal TBS and fracture was no longer statistically significant. There was a similar-magnitude, marginally statistically significant, association between early postmenopausal TBS and fracture, unadjusted for BMD (RH 1.15 [0.95-1.39]). CONCLUSIONS Variation in premenopausal TBS is related to fracture risk, but this association is not independent of BMD.
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Affiliation(s)
- Gail A Greendale
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States of America.
| | - MeiHua Huang
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States of America.
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, Crabtree Hall A547, 130 DeSoto Street, Pittsburgh, PA, 15261, United States of America.
| | - Sioban Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 1415 Washington Heights, Room 6618, Ann Arbor, MI 48109, United States of America.
| | - Joel S Finkelstein
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, 50 Blossom St, Boston, MA 02114, United States of America.
| | - Arun S Karlamangla
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States of America.
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Shayganfar A, Farrokhi M, Shayganfar S, Ebrahimian S. Associations between bone mineral density, trabecular bone score, and body mass index in postmenopausal females. Osteoporos Sarcopenia 2020; 6:111-114. [PMID: 33102803 PMCID: PMC7573495 DOI: 10.1016/j.afos.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives Bone mineral density (BMD), as a gold standard determinant of osteoporosis, assesses only one of many characteristics contributing to the bone. Trabecular bone score (TBS) is applied to evaluate the microarchitecture of trabecular bone. A high body mass index (BMI) has been reported to have a positive correlation with BMD. However, the relation between BMI and TBS has remained unclear. Therefore, the aim of this study is to shed light on the associations between BMI, T-score, and TBS in postmenopausal women without a diagnosed underlying disease. Methods In this cross-sectional study, 1054 postmenopausal women were randomly recruited from the Department of Radiology, Isfahan University of Medical Sciences. Demographic characteristics and medical history of all subjects were collected from documents. TBS measurements for L1-L4 vertebrae were retrospectively performed by the TBS iNsight software using the dual X-ray absorptiometry (DXA) from the same region of spine of the subjects. The analysis was done to detect the correlation between TBS and BMI. Results A statistically significant negative correlation was found between TBS and BMI in patients with osteoporosis and low bone mass. In patients with normal T-scores, BMI was not significantly correlated to TBS (P > 0.05). Furthermore, there was a significant positive association between T-score and BMI. Conclusions Although a higher BMI had a protective effect against osteoporosis, higher BMI was associated with a lower TBS in patients with an abnormal T-score. However, BMI did not have a significant effect on TBS in patients with normal T-scores.
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Affiliation(s)
- Azin Shayganfar
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Farrokhi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Shayganfar
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Ebrahimian
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Greendale GA, Huang M, Cauley JA, Liao D, Harlow S, Finkelstein JS, Hans D, Karlamangla AS. Trabecular Bone Score Declines During the Menopause Transition: The Study of Women's Health Across the Nation (SWAN). J Clin Endocrinol Metab 2020; 105:dgz056. [PMID: 31613958 PMCID: PMC7069840 DOI: 10.1210/clinem/dgz056] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT Rapid bone density loss starts during the menopause transition (MT). Whether other components of bone strength deteriorate before the final menstrual period (FMP) remains uncertain. OBJECTIVE To discern whether trabecular bone score (TBS) declines during the MT. DESIGN An 18-year longitudinal analysis from the Study of Women's Health Across Nation. SETTING Community-based cohort. PARTICIPANTS A total of 243 black, 164 Japanese, and 298 white, initially pre- or early perimenopausal women, who experienced their FMP. MAIN OUTCOME MEASURES TBS, an indicator of bone strength. RESULTS Multivariable mixed effects regressions fitted piecewise linear models to repeated measures of TBS as a function of time before or after the FMP; covariates were age at FMP, race/ethnicity, and body mass index. Prior to 1.5 years before the FMP, in the referent individual (a white woman with age at FMP of 52.2 years and body mass index of 28.0 kg/m2), TBS evidenced no change (slope 0.12% per year, P = 0.2991). TBS loss began 1.5 years before the FMP, declining by 1.16% annually (P < 0.0001). Starting 2 years after the FMP, annual rate of TBS loss lessened to 0.89% (P < 0.0001). In the 5 years before through the 5 years after the FMP, in the referent individual, total TBS decline was 6.3% (P < 0.0001), but black participants' total TBS loss was 4.90% (P = 0.0008, difference in black and white 10-year change). Results for Japanese did not differ from those of white women. CONCLUSIONS The occurrence of an MT-related decline in TBS supports the thesis that this period is particularly damaging to skeletal integrity.
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Affiliation(s)
- Gail A Greendale
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, Los Angeles, CA
| | - MeiHua Huang
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, Los Angeles, CA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, Pittsburgh, PA
| | - Diana Liao
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, Los Angeles, CA
| | - Sioban Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Joel S Finkelstein
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA
| | - Didier Hans
- Center of Bone Diseases - Bone and Joint Department (DAL – RHU), Lausanne University Hospital & University of Lausanne, Lausanne, Switzerland
| | - Arun S Karlamangla
- Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, Los Angeles, CA
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Shevroja E, Aubry-Rozier B, Hans G, Gonzalez- Rodriguez E, Stoll D, Lamy O, Hans D. Clinical Performance of the Updated Trabecular Bone Score (TBS) Algorithm, Which Accounts for the Soft Tissue Thickness: The OsteoLaus Study. J Bone Miner Res 2019; 34:2229-2237. [PMID: 31419331 DOI: 10.1002/jbmr.3851] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/02/2019] [Accepted: 07/19/2019] [Indexed: 01/02/2023]
Abstract
Regional soft tissue may have a noise effect on trabecular bone score (TBS) and eventually alter its estimate. The current TBS software (TBS iNsight®) is based on an algorithm accounting for body mass index (BMI) (TBSv3.03 ). We aimed to explore the updated TBS algorithm that accounts for soft tissue thickness (TBSv4.0 ). This study was embedded in the OsteoLaus cohort of women in Lausanne, Switzerland. Hip and lumbar spine (LS) dual-energy X-ray absorptiometry (DXA) scans were performed using Discovery A System (Hologic). The incident major osteoporotic fractures (MOFs) were assessed from vertebral fracture assessments using Genant's method (vertebral MOF) or questionnaires (nonvertebral MOF). We assessed the correlations of bone mineral density (BMD) or TBS with body composition parameters; MOF prediction ability of both versions of TBS; and the differences between Fracture Risk Assessment Tool (FRAX) adjusted for TBSv3.03 or TBSv4.0 . In total, 1362 women with mean ± SD age 64.4 ± 7.5 years and mean ± SD BMI 25.9 ± 4.5 kg/m2 were followed for 4.4 years and 132 experienced an MOF. All the anthropometric measurements of our interest were positively correlated with LS, femoral neck, or hip BMD and TBSv4.0 ; whereas with TBSv3.03 their correlations were negative. In the models adjusted for age, soft tissue thickness, osteoporotic treatment, and LS-BMD, for each SD decline in TBSv3.03 , there was a 43% (OR 1.43; 95% CI, 1.12 to 1.83) increase in the odds of having MOF; whereas for each SD decline in TBSv4.0 , there was a 54% (OR 1.54; 95% CI, 1.18 to 2.00) increase in the odds of having an MOF. Both FRAXs were very strongly correlated and the mild differences were present in the already high-risk women for MOF. This study shows that TBSv4.0 overcomes the debatable residual negative correlation of the current TBS with body size and composition parameters, postulating itself as free from the previously acknowledged technical limitation of TBS. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Enisa Shevroja
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Bérengère Aubry-Rozier
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Gabriel Hans
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Elena Gonzalez- Rodriguez
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Delphine Stoll
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Lamy
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
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Fuggle NR, Curtis EM, Ward KA, Harvey NC, Dennison EM, Cooper C. Fracture prediction, imaging and screening in osteoporosis. Nat Rev Endocrinol 2019; 15:535-547. [PMID: 31189982 DOI: 10.1038/s41574-019-0220-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Osteoporosis is associated with increased fragility of bone and a subsequent increased risk of fracture. The diagnosis of osteoporosis is intimately linked with the imaging and quantification of bone and BMD. Scanning modalities, such as dual-energy X-ray absorptiometry or quantitative CT, have been developed and honed over the past half century to provide measures of BMD and bone microarchitecture for the purposes of clinical practice and research. Combined with fracture prediction tools such as Fracture Risk Assessment Tool (FRAX) (which use a combination of clinical risk factors for fracture to provide a measure of risk), these elements have led to a paradigm shift in the ability to diagnose osteoporosis and predict individuals who are at risk of fragility fracture. Despite these developments, a treatment gap exists between individuals who are at risk of osteoporotic fracture and those who are receiving therapy. In this Review, we summarize the epidemiology of osteoporosis, the history of scanning modalities, fracture prediction tools and future directions, including the most recent developments in prediction of fractures.
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Affiliation(s)
- Nicholas R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
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Messina C, Buonomenna C, Menon G, Magnani S, Albano D, Gitto S, Ulivieri FM, Sconfienza LM. Fat Mass Does Not Increase the Precision Error of Trabecular Bone Score Measurements. J Clin Densitom 2019; 22:359-366. [PMID: 30661747 DOI: 10.1016/j.jocd.2019.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Trabecular bone score (TBS) is an indirect index of trabecular microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry. Previous phantom study showed that an increase in soft tissue thickness does not affect TBS reproducibility. We investigated the effect of increasing body mass index (BMI) and waist circumference on TBS precision error on patients, compared to bone mineral density (BMD). METHODOLOGY A population of postmenopausal Caucasian women was distributed in 3 different BMI (normal, overweight, and class I obesity), plus 2 further groups based on waist circumference diameter (≤88 cm and >88 cm, respectively). In vivo precision error was calculated on 30 consecutive subjects that were scanned 2 times, with patient repositioning, using the Hologic QDR-Discovery W densitometer. Coefficient of variation, percent least significant change, and reproducibility were calculated according to the International Society for Clinical Densitometry guidelines. RESULTS Ninety-five women aged 66 ± 10 (mean ± standard deviation) were included. No significant differences were found both for BMD and TBS precision errors, respectively, when comparing BMI groups and waist circumference groups. BMD reproducibility ranged from 95.9% (BMI > 30 kg/m2) to 97.5% (BMI < 25 kg/m2). TBS reproducibility ranged between 95.8% (BMI = 25-29.9 kg/m2, waist circumference > 88 cm) and 96.6% (BMI < 25 kg/m2). With the exception of obese group, a significant difference was found between BMD and TBS reproducibility, being that of TBS slightly lower than BMD. A significant decrease of TBS values was found between normal and obese subjects, as well as between waist circumference groups. CONCLUSIONS TBS precision error is not affected by BMI and waist circumference differences. TBS reproducibility showed to be slightly lower than that of BMD, but this difference was mitigated in obese patients. A negative association was found between the amount of fat mass and TBS mean values.
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Affiliation(s)
- Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Ciriaco Buonomenna
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Giorgia Menon
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sandro Magnani
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Domenico Albano
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Salvatore Gitto
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Fabio Massimo Ulivieri
- Bone Metabolic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Medicina Nucleare, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Abstract
PURPOSE OF REVIEW Trabecular bone score (TBS) is a texture index derived from the lumbar spine dual-energy X-ray absorptiometry which can assess skeletal quality and provide information about fracture risk independent of bone mineral density (BMD). TBS is useful in assessing osteoporotic fracture risk, with lower TBS values associated with increased fracture risk. In this article, we review the current state of TBS, including its utility and limitations in the assessment and management of osteoporosis, with particular emphasis on the recent literature. RECENT FINDINGS Ten-year fracture risk assessment using the FRAX tool can be improved through the use of a TBS adjustment. The use of TBS-adjusted FRAX can change management in a modest but significant number of patients, particularly in those close to an intervention threshold. Change in lumbar spine TBS for patients undergoing antiresorptive treatment is not a useful indicator of antifracture effect. SUMMARY Lumbar spine TBS provides information complementary to conventional BMD, and has been shown to be clinically useful for enhancing fracture risk prediction.
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30
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Jain RK, Vokes T. Physical activity as measured by accelerometer in NHANES 2005-2006 is associated with better bone density and trabecular bone score in older adults. Arch Osteoporos 2019; 14:29. [PMID: 30826896 DOI: 10.1007/s11657-019-0583-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/25/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED In an analysis of NHANES 2005-2006, older, but not younger, women and men with higher levels of physical activity had higher TBS, total hip T-score, and femoral neck T-score. Even modest levels of physical activity may be a crucial component of bone health maintenance. PURPOSE Physical activity is associated with improved bone parameters in adolescence, but it is not clear if this persists into adulthood. Further, it is unclear how low levels of physical activity as measured by accelerometer may impact bone parameters. METHODS We analyzed data from subjects from NHANES 2005-2006 over the age of 20 who had accelerometry and bone mineral density (BMD) testing. We analyzed women and men separately and grouped by over or under 50 years of age: 484 younger women, 486 older women, 604 younger men, and 609 older men. Moderate-to-vigorous physical activity (MVPA) was categorized as low (less than 5 min daily), intermediate (5-20 min daily), or high (at least 20 min daily). RESULTS Among younger women and men, there was no significant relationship between MVPA and BMD or trabecular bone score (TBS). Conversely, older women with intermediate and high MVPA had higher TBS (1.360 ± 0.008 and 1.377 ± 0.009 vs 1.298 ± 0.010, p < 0.001), total hip T-score (- 1.02 ± 0.13 and - 0.90 ± 0.09 vs. - 1.51 ± 0.08, p < 0.01), and femoral neck T-score than women with low MVPA, respectively. Similarly, older men with high MVPA had higher TBS, total hip T-score, and femoral neck T-score than men with intermediate and low MVPA. CONCLUSIONS Older, but not younger, women and men with higher levels of activity had higher BMD and TBS. Benefits were noted with as little as 5-20 min of daily physical activity. Our results suggest that physical activity is a crucial component of bone health maintenance.
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Affiliation(s)
- Rajesh K Jain
- Section of Metabolism, Diabetes, and Endocrinology, Lewis Katz School of Medicine at Temple University, 3322 N Broad St, Ste 205, Philadelphia, PA, 19140, USA.
| | - Tamara Vokes
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago Medicine, Chicago, IL, 60611, USA
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31
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Trinh A, Wong P, Fahey MC, Ebeling PR, Fuller PJ, Milat F. Trabecular bone score in adults with cerebral palsy. Bone 2018; 117:1-5. [PMID: 30193871 DOI: 10.1016/j.bone.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/06/2018] [Accepted: 09/03/2018] [Indexed: 01/14/2023]
Abstract
CONTEXT Bone fragility in cerebral palsy (CP) is secondary to a complex interplay of functional, hormonal, and nutritional factors that affect bone remodelling. A greater understanding of bone microarchitectural changes seen in CP should assist therapeutic decision making. OBJECTIVE To examine the relationship between trabecular bone score (TBS), BMD and fractures in adults with CP; the influence of clinical factors and body composition on bone microarchitecture were explored. DESIGN Retrospective cross-sectional study. SETTING AND PARTICIPANTS 43 adults (25 male) with CP of median age 25 years (interquartile range 21.4-33.9) who had evaluable dual-energy X-ray absorptiometry imaging of the lumbar spine from a single tertiary hospital between 2005-March 2018. RESULTS 24/43 (55.8%) of patients had TBS values indicating intermediate or high risk of fracture (<1.31). TBS correlated with areal BMD at the lumbar spine, femoral neck and total body. TBS was significantly associated with arm and leg lean mass, with adjustment for age, gender and height (adjusted R2 = 0.18, p = 0.042 for arm lean mass; adjusted R2 = 0.19, p = 0.036 for leg lean mass). There was no difference in TBS when patients were grouped by fracture status, anticonvulsant use, gonadal status or use of PEG feeding. TBS was lower in non-ambulatory patients compared with ambulatory patients (1.28 vs 1.37, p = 0.019). CONCLUSIONS Abnormal bone microarchitecture, as measured by TBS, was seen in >50% of young adults with CP. TBS correlated with both areal BMD and appendicular lean mass. Maintaining muscle function is likely to be important for bone health in young adults with CP and needs to be confirmed in further studies.
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Affiliation(s)
- A Trinh
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia.
| | - P Wong
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia
| | - M C Fahey
- Hudson Institute of Medical Research, Clayton, Australia; Departments of Paediatrics, Monash Health and Monash University, Clayton, Australia
| | - P R Ebeling
- Department of Endocrinology, Monash Health, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
| | - P J Fuller
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
| | - F Milat
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
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Ferrari SL, Abrahamsen B, Napoli N, Akesson K, Chandran M, Eastell R, El-Hajj Fuleihan G, Josse R, Kendler DL, Kraenzlin M, Suzuki A, Pierroz DD, Schwartz AV, Leslie WD. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int 2018; 29:2585-2596. [PMID: 30066131 PMCID: PMC6267152 DOI: 10.1007/s00198-018-4650-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.
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Affiliation(s)
- S L Ferrari
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 1205, Geneva, Switzerland.
| | - B Abrahamsen
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - K Akesson
- Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden
| | - M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - R Eastell
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - G El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - R Josse
- Department of Medicine and Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - M Kraenzlin
- Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland
| | - A Suzuki
- Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - A V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Leere JS, Kruse C, Robaczyk M, Karmisholt J, Vestergaard P. Associations between trabecular bone score and biochemistry in surgically vs conservatively treated outpatients with primary hyperparathyroidism: A retrospective cohort study. Bone Rep 2018; 9:101-109. [PMID: 30116767 PMCID: PMC6092478 DOI: 10.1016/j.bonr.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/06/2018] [Accepted: 08/08/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Trabecular Bone Score (TBS) is a software-based method for indirect assessment of trabecular bone structure of the spine, based on analysis of pixels in dual energy x-ray absorptiometry (DXA) images. Few studies describe the use of TBS in patients with primary hyperparathyroidism (PHPT). This study aimed at further describing this relationship, investigating possible correlations between biochemistry, body mass index (BMI), fracture incidence and TBS. METHODS Cross-sectional study of 195 patients with verified PHPT, surgically (27) or conservatively (168) treated at the Department of Endocrinology, Aalborg University Hospital. TBS was acquired by reanalyzing DXA-images of the included subjects from the outpatient clinic. Biochemical variables were obtained from clinical routine blood samples taken in relation to the DXA-scans. History of fractures and medical history was obtained from radiology reports and medical charts. RESULTS Patients with active PHPT had a TBS-score signifying a partly degraded bone structure, whereas surgically treated patients had a normal bone structure as judged by TBS, though the difference in TBS-score was not statistically significant. Use of antiresorptive treatment was negatively associated with BMD but not TBS. No correlations between the biochemical variables and TBS were found. A negative correlation between TBS and BMI in patients with PHPT was present. Patients experiencing a fragility fracture had a significantly lowered TBS, BMD and T-Score. CONCLUSION Biochemistry does not seem to predict bone status in terms of TBS in patients with PHPT. TBS is negatively correlated to BMI, which is also seen in patients not suffering from PHPT. The lack of a predictive value for antiresorptive treatment for TBS may raise concern. TBS appears to have a predictive value when assessing risk of fracture in patients with PHPT. MINI ABSTRACT This cross-sectional study investigates possible correlations between biochemical variables, body mass index (BMI) and trabecular bone score (TBS) in 195 patients with primary hyperparathyroidism. It finds no correlation between biochemical variables and TBS, but finds a negative correlation between TBS and BMI and a clear association between fracture incidence and low TBS-score.
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Affiliation(s)
| | - Christian Kruse
- Department of Clinical Medicine, Aalborg University, Denmark
- Steno Diabetes Center North Jutland, Denmark
| | - Maciej Robaczyk
- Department of Endocrinology, Aalborg University Hospital, Denmark
| | - Jesper Karmisholt
- Department of Clinical Medicine, Aalborg University, Denmark
- Department of Endocrinology, Aalborg University Hospital, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Denmark
- Department of Endocrinology, Aalborg University Hospital, Denmark
- Steno Diabetes Center North Jutland, Denmark
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Jain RK, Vokes T. Association of trabecular bone score (TBS) and prior fracture differs among minorities in NHANES 2005-2008. Osteoporos Int 2018; 29:2093-2099. [PMID: 29858633 DOI: 10.1007/s00198-018-4584-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/21/2018] [Indexed: 01/14/2023]
Abstract
UNLABELLED The study investigates the association of trabecular bone score (TBS) and fractures among minority populations. In NHANES 2005-2008, TBS was associated with history of fractures in Caucasian subjects but demonstrated somewhat weaker associations in African American and Mexican American women. INTRODUCTION Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA image, predicts fractures well in Caucasian (CA) and Asian populations but is less well studied in African American (AA) and Mexican American (MA) subjects. It is not clear whether TBS is associated with or is predictive of fragility in these racial/ethnic groups. METHODS We analyzed data from subjects from NHANES 2005-2008 over the age of 40 who had TBS: 1178 CA, 467 AA, and 397 MA women and 1200 CA, 502 AA, and 386 MA men. TBS was categorized into normal, ≥ 1.310, partially degraded < 1.310, and > 1.230, or degraded, ≤ 1.230. History of fracture was assessed by questionnaire. RESULTS Among women, there was an increasing prevalence of fracture with worsening TBS category. However, when controlling for age, BMI, and low T-score, the association between TBS category and previous fracture was only significant in CA women (OR 1.49 per worsening category, 95% CI 1.20-1.85). In men, there was also an increase in the prevalence of fracture with worsening TBS category in all races/ethnicities. When controlling for age, BMI, and low T-score, the association between TBS category and previous fracture was only significant in CA men (OR 1.47 per worsening category, 95% CI 1.10-1.95), though analysis was somewhat limited by small fracture numbers. CONCLUSIONS The association of fracture and TBS varies by race/ethnicity and gender with weaker association observed in AA and MA women. More research is needed to define the proper use of TBS for predicting fractures in minority groups.
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Affiliation(s)
- R K Jain
- Section of Metabolism, Diabetes, and Endocrinology, Lewis Katz School of Medicine at Temple University, 3322 N Broad St, Ste 205, Philadelphia, PA, 19140, USA.
| | - T Vokes
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago Medicine, Chicago, IL, 60611, USA
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Messina C, Poloni A, Chianca V, Albano D, Piodi LP, Ulivieri FM, Sconfienza LM. Increasing soft tissue thickness does not affect trabecular bone score reproducibility: a phantom study. Endocrine 2018; 61:336-342. [PMID: 29948934 DOI: 10.1007/s12020-018-1647-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/03/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Trabecular Bone Score (TBS) provides an indirect score of trabecular microarchitecture from lumbar spine (LS) dual energy X-ray absorptiometry. Increasing soft tissue thickness artifactually reduces TBS values; we evaluated the effect of a fictitious increase of soft tissue thickness on TBS and bone mineral density (BMD) reproducibility on a phantom model. METHODS A Hologic spine phantom was scanned with a QDR-Discovery W Hologic densitometer. Fresh pork rind layers of 5 mm were used to simulate the in-vivo soft tissues. For each scan mode (fast array [FA], array, high definition [HD]), 25 scans were consecutively performed without phantom repositioning, at 0 (no layers), 1 cm, 3 cm, and 6 cm of thickness. BMD and TBS reproducibility was calculated as the complement to 100% of least significant change. RESULTS Both BMD and TBS reproducibility slightly decreased with increasing soft tissue; this difference was statistically significant only for BMD using HD modality (reproducibility decreased from 99.4% at baseline to 98.4% at 6-cm of thickness). TBS reproducibility was slightly lower compared to that of BMD, and ranged between 98.8% (array, 0 cm) and 97.4% (FA, 6 cm). Without taking into account manufacturer BMI optimization, we found a progressive decrease of TBS mean values with increasing soft tissue thickness. The highest TBS difference between baseline scan and 6 cm was -0.179 (-14.27%) using HD. CONCLUSIONS Despite being slightly lower than that of BMD, TBS reproducibility was not affected up to 6 cm of increasing soft tissue thickness, and was even less influenced by fat than BMD reproducibility.
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Affiliation(s)
- Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Alessandro Poloni
- Reparto di Radiologia, ASST Bergamo Est Ospedale Bolognini, Via Paderno 21, 24068, Seriate, Italy
| | - Vito Chianca
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Via Panzini 5, Napoli, Italy
| | - Domenico Albano
- Sezione di Scienze Radiologiche, Di.Bi.Med., Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Luca Petruccio Piodi
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Massimo Ulivieri
- Bone Metabolic Unit, Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Schousboe JT, Vo TN, Langsetmo L, Taylor BC, Kats AM, Schwartz AV, Bauer DC, Cauley JA, Ensrud KE. Predictors of change of trabecular bone score (TBS) in older men: results from the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 2018; 29:49-59. [PMID: 29090329 PMCID: PMC5777142 DOI: 10.1007/s00198-017-4273-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/12/2017] [Indexed: 02/08/2023]
Abstract
Among older men, characteristics that predict longitudinal changes in trabecular bone score (TBS) are different from characteristics that predict changes in bone mineral density (BMD). Most notably, weight loss is strongly associated with concomitant loss in BMD but with concomitant increases in TBS, when measured on Hologic densitometers. INTRODUCTION Our objective was to compare and contrast predictors of changes in TBS, total hip BMD, and lumbar spine BMD. METHODS Our study population was 3969 Osteoporotic Fractures in Men (MrOS) cohort participants (mean age 72.8 years) with repeat measures of TBS, lumbar spine and total hip BMD, body mass index (BMI) less than 37 kg/m2, and no use of bisphosphonate or glucocorticoid medications. TBS was scored (Med-Imaps Software version 2.1) and BMD measured on Hologic densitometers. RESULTS One thousand four hundred forty-four men had a TBS decrease > 0.04 units (estimated least significant change for TBS), 795 men had a TBS increase > 0.04 units, and 1730 men had TBS change ≤ 0.04 units over mean follow-up of 4.6 years. Older age was not associated with TBS change, but was associated with greater decline in lumbar spine and total hip BMD. Compared to stable weight, > 10% weight loss was strongly associated with an increase in TBS [effect size = 1.24 (95% CI 1.12, 1.36)] and strongly associated with a decrease in total hip BMD [- 1.16 (95% CI - 1.19, - 1.03)]. Other predictors discordant for longitudinal changes of TBS and BMD included baseline BMI, walk speed, and ACE inhibitor use. CONCLUSIONS Predictors of changes in TBS are different from predictors of changes in lumbar spine and total hip BMD. At least when assessed on Hologic densitometers, weight loss is associated with subsequent declines in spine and total hip BMD but subsequent increase in TBS. Faster walk speed may protect against loss of hip BMD, but is not associated with longitudinal changes of TBS.
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Affiliation(s)
- J T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, 3800 Park Nicollet Blvd., Minneapolis, MN, 55416, USA.
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
| | - T N Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - L Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - B C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - A M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - A V Schwartz
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - D C Bauer
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - J A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - K E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Martineau P, Silva BC, Leslie WD. Utility of trabecular bone score in the evaluation of osteoporosis. Curr Opin Endocrinol Diabetes Obes 2017; 24:402-410. [PMID: 28857846 DOI: 10.1097/med.0000000000000365] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Trabecular bone score (TBS) is a lumbar spine dual-energy absorptiometry texture index which provides information on skeletal quality partially independent of bone mineral density (BMD). A body of work has emerged demonstrating the relationship between TBS and fracture risk, with lower TBS values associated with increased risk for osteoporotic fracture in postmenopausal women and older men. TBS is derived from standard DXA images; however, the information provided by TBS is complementary to that provided by BMD. In this article, we review the current state of TBS and its evolving role in the assessment and management of osteoporosis, with particular emphasis on the literature of the previous year. RECENT FINDINGS TBS-adjusted The Fracture Risk Assessment tool (FRAX) probabilities enhance fracture risk prediction compared with conventional FRAX predictions. TBS has been found to better categorize fracture risk and assists in FRAX-based treatment decisions, particularly for patients close to an intervention threshold. However, change in lumbar spine TBS while undergoing antiresorptive treatment is not a useful indicator of antifracture effect. SUMMARY Lumbar spine TBS is a recently developed image-based software technique for skeletal assessment, complementary to conventional BMD, which has been shown to be clinically useful as a fracture risk prediction tool.
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Affiliation(s)
- Patrick Martineau
- aUniversity of Ottawa, Ottawa, Ontario, Canada bUNI-BH, Santa Casa Hospital, Belo Horizonte, Brazil cUniversity of Manitoba, Winnipeg, Manitoba, Canada
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Schacter GI, Leslie WD, Majumdar SR, Morin SN, Lix LM, Hans D. Clinical performance of an updated trabecular bone score (TBS) algorithm in men and women: the Manitoba BMD cohort. Osteoporos Int 2017; 28:3199-3203. [PMID: 28733715 DOI: 10.1007/s00198-017-4166-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/17/2017] [Indexed: 01/09/2023]
Abstract
UNLABELLED This is the first study to directly compare the original and recently updated versions of the trabecular bone score (TBS) algorithm. We confirmed improved performance of the new algorithm, especially among men. INTRODUCTION Lumbar spine trabecular bone score (TBS) predicts major osteoporotic fractures (MOFs) and hip fractures (HFs) independent of bone density. The original TBS algorithm (version 1; [TBS-v1]) was optimized for women of average body size. Limitations were identified when used in men or extremes of body mass index (BMI). The current study evaluates an updated TBS algorithm (version 2; [TBS-v2]) modified to address these issues. METHODS From a registry with all DXA results for Manitoba, Canada, we identified 47,736 women and 4348 men age ≥ 40 with baseline spine DXA (GE Prodigy, 1999-2011). Spine TBS was measured using both TBS-v1 and TBS-v2 algorithms. Risk stratification for incident fractures identified from population-based data was assessed from area under the receiver operating characteristic curve (AUROC). RESULTS With the TBS-v1 algorithm, average TBS for men was significantly lower than for women (p < 0.001) and showed significant inverse correlations with BMI (Pearson r-0.40 in men, -0.18 in women [both p < 0.001]). With the TBS-v2 algorithm, average values for men were slightly greater than for women (p < 0.001) and there were no significant correlations with BMI (Pearson r 0.01 in men, -0.01 in women [both p > 0.1]). During mean follow-up of 5 years in men, there were 214 incident MOFs and 47 HFs; during 6 years mean follow-up in women, there were 2895 incident MOFs and 694 HFs. Improvements in fracture prediction were seen with TBS-v2 in both men (change in AUROC for MOFs +0.021 [p = 0.17], HFs +0.046 [p = 0.04]) and women (change in AUROC for MOFs +0.012 [p < 0.001], HFs +0.020 [p < 0.001]). CONCLUSION The updated TBS algorithm is less affected by BMI, gives higher mean results for men than women consistent with their lower fracture risk, and improves fracture prediction in both men and women.
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Affiliation(s)
- G I Schacter
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - W D Leslie
- University of Manitoba, Winnipeg, Manitoba, Canada.
- Department of Medicine (C5121), 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
| | - S R Majumdar
- University of Alberta, Edmonton, Alberta, Canada
| | - S N Morin
- McGill University, Montreal, Quebec, Canada
| | - L M Lix
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - D Hans
- Center of Bone Diseases, Bone and Joints Department, Lausanne University Hospital, Lausanne, Switzerland
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