A multicentre, retrospective case–control study assessing the role of trabecular bone score (TBS) in menopausal Caucasian women with low areal bone mineral density (BMDa): Analysing the odds of vertebral fracture

Rabier, Bénédicte; Héraud, Alain; Grand-Lenoir, Catherine; Winzenrieth, Renaud; Hans, Didier

doi:10.1016/j.bone.2009.06.032

Cited by 150 publications

(95 citation statements)

References 15 publications

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“…(20)(21)(22) Indeed, previous studies demonstrated that TBS is strongly correlated with bone microarchitecture, regardless of BMD, (23) and documented the added value of TBS in bone mineral densitometry for fracture risk assessment in postmenopausal osteoporosis. (24)(25)(26)(27) We found that TBS, but not LS-BMD, is associated with prevalent vertebral fractures regardless of age, BMI, and gender. More importantly, in a subgroup of patients followed over time, TBS was able to predict incident fractures independently of LS-BMD and age, BMI, and gender.…”

Section: Discussionmentioning

confidence: 58%

“…(20)(21)(22) TBS has been demonstrated to be strongly correlated with bone microarchitecture, regardless of BMD, (23) and several studies (24)(25)(26) have documented the added value of TBS in bone mineral densitometry for fracture risk assessment in postmenopausal osteoporosis. (22)(23)(24)(25)(26)(27) Few data are available regarding TBS in patients with glucocorticoid induced osteoporosis, (28,29) and no studies evaluated bone microarchitecture by TBS in SH patients.…”

Section: Introductionmentioning

confidence: 99%

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Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism

Eller-Vainicher

Morelli

Ulivieri

et al. 2012

Journal of Bone and Mineral Research

127

128

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Patients with adrenal incidentalomas (AIs) and subclinical hypercortisolism (SH) have increased risk of fracture independent of bone mineral density (BMD) and possibly due to reduced bone quality. The trabecular bone score (TBS) has been proposed as a index of bone microarchitecture. The aim of the study was to investigate TBS in AI. In 102 AI patients, SH was diagnosed in the presence of at least two of the following: (1) urinary free cortisol >70 mg/24 h (193.1 nmol/L); (2) cortisol after 1-mg dexamethasone suppression test (1-mg DST) >3.0 mg/dL (82.8 nmol/L); or (3) adrenocorticotropic hormone (ACTH) <10 pg/mL (<2.2 pmol/L). In patients and in 70 matched controls, BMD was measured at lumbar spine (LS) and femur (neck [FN] and total [FT]) by dual X-ray absorptiometry and TBS was assessed in the region of LS-BMD; BMD and TBS data were reported as Z-scores. In patients, vertebral deformities were assessed by radiograph. Patients with SH (n ¼ 34) had lower LS-BMD (À0.31 AE 1.17), FT-BMD (À0.29 AE 0.91), and TBS (À3.18 AE 1.21) than patients without SH (n ¼ 68, 0.31 AE 1.42, p ¼ 0.03; 0.19 AE 0.97, p ¼ 0.01; À1.70 AE 1.54, p < 0.0001, respectively) and controls (0.42 AE 1.52, p ¼ 0.02; 0.14 AE 0.76, p ¼ 0.02; À1.19 AE 0.99, p < 0.0001, respectively). TBS was inversely correlated with 1-mg DST (b ¼ À0.26, t ¼ À2.79, p ¼ 0.006) regardless of age, LS-BMD, body mass index (BMI), and gender. The presence of fracture was associated with low TBS alone (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.85-12.42, p ¼ 0.001) and with the cluster low TBS plus low LS-BMD (OR, 4.37; 95% CI, 1.71-11.4, p ¼ 0.002), after adjustment for age, BMI, and gender. Low TBS plus low LS-BMD showed a good specificity (79%) for predicting fractures, whereas normal TBS (ie, > À1.5) plus normal LS-BMD high specificity (88.1%) for excluding fractures. Finally, TBS predicted the occurrence of a new fracture in 40 patients followed for 24 months (OR, 11.2; 95%CI, 1.71-71.41, p ¼ 0.012) regardless of LS-BMD, BMI, and age. In SH, bone quality, as measured by TBS, is altered. TBS is useful in detecting AI patients at risk of fractures. ß

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism

Eller-Vainicher

Morelli

Ulivieri

et al. 2012

Journal of Bone and Mineral Research

127

128

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“…Although 35% of treated patients showed a significant TBS increase consistent with a microarchitectural texture improvement, 65% remained below LSC such that the overall effects of ZOL on bone trabeculae can be considered as a preservation of vertebral microarchitectural texture in the majority of patients (Krieg and colleagues, unpublished work). (38) In several studies, (16,(19)(20)(21) TBS has been found to: (1) be lower in postmenopausal women with a past osteoporotic fracture relative to age-and BMD-matched women without fracture; (2) as it decreases, incrementally increase the odds ratio for spine fracture when combined with LS BMD; (3) to be lower in women with fractures, irrespective of whether their BMD meets the criteria for osteoporosis or osteopenia; (4) prospectively predict fracture as well as LS BMD; and (5) to capture roughly one-third of fractures misclassified using the BMD-dependent WHO definition of osteoporosis alone. With this study being considered as a first step, further studies with other bone active substances, such as teriparatide, are needed to elucidate whether, and if so to what extent, the combination of BMD and TBS assessments may contribute to improve monitoring of osteoporosis treatment at the individual patient level.…”

Section: Discussionmentioning

confidence: 99%

Effects of zoledronate versus placebo on spine bone mineral density and microarchitecture assessed by the trabecular bone score in postmenopausal women with osteoporosis: A three-year study

Popp

Guler

Lamy

et al. 2012

Journal of Bone and Mineral Research

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The trabecular bone score (TBS) is an index of bone microarchitectural texture calculated from anteroposterior dual-energy X-ray absorptiometry (DXA) scans of the lumbar spine (LS) that predicts fracture risk, independent of bone mineral density (BMD). The aim of this study was to compare the effects of yearly intravenous zoledronate (ZOL) versus placebo (PLB) on LS BMD and TBS in postmenopausal women with osteoporosis. Changes in TBS were assessed in the subset of 107 patients recruited at the Department of Osteoporosis of the University Hospital of Berne, Switzerland, who were included in the HORIZON trial. All subjects received adequate calcium and vitamin D3. In these patients randomly assigned to either ZOL (n ¼ 54) or PLB (n ¼ 53) for 3 years, BMD was measured by DXA and TBS assessed by TBS iNsight (v1.9) at baseline and 6, 12, 24, and 36 months after treatment initiation. Baseline characteristics (mean AE SD) were similar between groups in terms of age, 76.8 AE 5.0 years; body mass index (BMI), 24.5 AE 3.6 kg/m 2 ; TBS, 1.178 AE 0.1 but for LS T-score (ZOL-2.9 AE 1.5 versus PLB-2.1 AE 1.5). Changes in LS BMD were significantly greater with ZOL than with PLB at all time points (p < 0.0001 for all), reaching þ9.58% versus þ1.38% at month 36. Change in TBS was significantly greater with ZOL than with PLB as of month 24, reaching þ1.41 versus-0.49% at month 36; p ¼ 0.031, respectively. LS BMD and TBS were weakly correlated (r ¼ 0.20) and there were no correlations between changes in BMD and TBS from baseline at any visit. In postmenopausal women with osteoporosis, once-yearly intravenous ZOL therapy significantly increased LS BMD relative to PLB over 3 years and TBS as of 2 years. ß

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“…A number of cross-sectional (24)(25)(26)(27)(28)(29) and prospective (15,16,30,31) studies have shown an association between LS TBS and vertebral, hip, and other types of osteoporotic fractures in postmenopausal women. A recent published cross-sectional study has also demonstrated that TBS is associated with fractures in men (32).…”

Section: Association Of Tbs With Fracture Riskmentioning

confidence: 99%

“…The studies in postmenopausal women were, in general, retrospective case-control studies, in which cases were women with vertebral fractures [confirmed either by radiographs or vertebral fracture assessment (VFA)] or with a history of hip (27) or other types of osteoporotic fractures (24)(25)(26)28,29). Control groups comprised women without evidence of any type of fragility fracture either not matched for age or BMD with cases (27,29), or matched with cases for age (25,26,28) or for age and BMI (24). Overall, TBS was significantly lower in cases than in controls, and both TBS and any BMD measurement were associated with fractures (Table 2).…”

Section: Association Of Tbs With Fracture Riskmentioning

confidence: 99%

Trabecular bone score: perspectives of an imaging technology coming of age

Silva

Bilezikian

2014

Arq Bras Endocrinol Metab

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The trabecular bone score (TBS) is a new method to describe skeletal microarchitecture from the dual energy X-ray absorptiometry (DXA) image of the lumbar spine. While TBS is not a direct physical measurement of trabecular microarchitecture, it correlates with micro-computed tomography (µCT) measures of bone volume fraction, connectivity density, trabecular number, and trabecular separation, and with vertebral mechanical behavior in ex vivo studies. In human subjects, TBS has been shown to be associated with trabecular microarchitecture and bone strength by high resolution peripheral quantitative computed tomography (HRpQCT). Cross--sectional and prospective studies, involving a large number of subjects, have both shown that TBS is associated with vertebral, femoral neck, and other types of osteoporotic fractures in postmenopausal women. Data in men, while much less extensive, show similar findings. TBS is also associated with fragility fractures in subjects with secondary causes of osteoporosis, and preliminary data suggest that TBS might improve fracture prediction when incorporated in the fracture risk assessment system known as FRAX. In this article, we review recent advances that have helped to establish this new imaging technology. Arq Bras Endocrinol Metab. 2014;58(5):493-503 Keywords Trabecular bone score; osteoporosis; fracture risk; bone mineral density; microarchitecture RESUMO TBS (do inglês, "trabecular bone score") é um novo método que estima a microarquitetura óssea a partir de uma imagem de densitometria óssea (DXA) da coluna lombar. Apesar de o TBS não ser uma medida física direta da microarquitetura trabecular, ele correlaciona-se com o volume ósseo, densidade da conectividade trabecular, número de trabéculas e separação trabecular medidos por microtomografia computadorizada (µCT), e com medidas mecânicas da resistência óssea vertebral em estudos ex vivo. Estudos em humanos confirmaram que o TBS associa-se a microarquitetura trabecular e resistência óssea medidas por tomografia computadorizada quantitativa periférica de alta resolução (HRpQCT). Estudos transversais e prospectivos, envolvendo um grande número de indivíduos, mostraram que o TBS é associado com fratura vertebral, de colo de fêmur e com outros tipos de fraturas osteoporóticas em mulheres na pós-menopausa. Dados em homens, apesar de escassos, mostram resultados semelhantes. Além disso, o TBS foi associado a fraturas por fragilidade em indivíduos com diversas causas secundárias de osteoporose e, dados preliminares, sugerem que o uso do TBS pode melhorar a previsão de fratura quando incorporado ao sistema de avaliação de risco de fratura (FRAX). Este artigo faz uma revisão de avanços recentes que têm ajudado a estabelecer esse novo mé-todo de imagem. Arq Bras Endocrinol Metab. 2014;58(5):493-503 Descritores

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A multicentre, retrospective case–control study assessing the role of trabecular bone score (TBS) in menopausal Caucasian women with low areal bone mineral density (BMDa): Analysing the odds of vertebral fracture

Cited by 150 publications

References 15 publications

Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism

Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism

Effects of zoledronate versus placebo on spine bone mineral density and microarchitecture assessed by the trabecular bone score in postmenopausal women with osteoporosis: A three-year study

Trabecular bone score: perspectives of an imaging technology coming of age

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