Associations between trabecular bone score and vertebral fractures in patients with axial spondyloarthritis

Kang, Kwi Young; Kim, In Je; Park, Sung-Hwan; Hong, Yeon Sik

doi:10.1093/rheumatology/key027

Cited by 23 publications

(21 citation statements)

References 38 publications

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“…was lower in groups A and B compared to group C. AxSpA patients with lower TBS have been found to be more liable to have vertebral fractures, which makes the tool useful in predicting the future risk of such events [7].…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, changes in bone mass re ect severity of the in ammation [5]. The early in ammatory phase of axSpA does not cause structural damage to the SIJs, while at later stages, structural damage is visible on Xray scans [7].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there are no speci c useful imaging techniques to diagnose and monitor osteoporosis in axSpA. Dual-energy X-ray absorptiometry (DXA) is the most widely implemented tool to measure bone mineral density (BMD) [7]. However, this technique comes with limitations associated with overestimation of results due to the presence of structural lesions [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Dual-energy X-ray absorptiometry (DXA) is the most widely implemented tool to measure bone mineral density (BMD) [7]. However, this technique comes with limitations associated with overestimation of results due to the presence of structural lesions [7,8]. Additionally, information regarding bone microarchitecture are not fully captured by BMD [9].…”

Section: Introductionmentioning

confidence: 99%

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Trabecular Bone Score and Bone Density in Patients With Non-radiographic Axial Spondyloarthritis

Hamoud¹,

Ghit²,

Ali³

et al. 2020

Preprint

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BackgroundSpondyloarthritis (SpA) represents a group of several inflammatory conditions. Ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) are considered to belong to SpA family of diseases. The aim of our study is to evaluate bone mineral density (BMD) and trabecular bone scores (TBS) scores in patients suffering from nr-axSpA.MethodsA cross-sectional study evaluating 160 patients. Inclusion criteria involved patients 18-45 years of age, having clinical features of SpA, and fulfilling Calin’s criteria for inflammatory low back pain. Patients were divided into 3 groups; group A (nr-axSpA) patients, group B (radiographic axial spondyloarthritis (r-axSpA)) patients, and group C (mechanical low back pain).Results Female to male ratio was significantly higher in group A compared to group B (63.3% vs. 36.7%) and (23.33% vs. 76.7%) (p< 0.001), respectively. While disease duration was significantly higher in group B in comparison to groups A and C (47.65±7.15, 18.56±6.55, and 14.76±4.20) (p<0.001), respectively. L1-L4 and L2-L4 TBS of groups A and B were significantly lower compared to group C (p<0.001). Additionally, a statistically significant decrease in BMD scores of L1-L4, femoral neck, and total hip bones was detected in group A compared to group C (p< 0.001).ConclusionPatients with nr-axSpA had a lower BMD and TBS compared to r-axSpA group (B) and control group (C), and it predominantly affected more females than males (3:1).

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trabecular Bone Score and Bone Density in Patients With Non-radiographic Axial Spondyloarthritis

Hamoud¹,

Ghit²,

Ali³

et al. 2020

Preprint

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“…TBS is not only associated with disease activity in patients with axSpA, as measured by inflammatory markers such as ESR and C-reactive protein and the Ankylosing Spondylitis Disease Activity Score (63,64,67), but is also negatively correlated with inflammation in patients with AS, as presented on lumbar spine magnetic resonance imaging (68). Additionally, we have reported a longitudinal association between disease activity measures and trabecular bone loss for 4 years in patients with axSpA (69).…”

Section: Trabecular Bone Scorementioning

confidence: 99%

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

Lim

Kang

2020

Front. Med.

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

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Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging

et al. 2023

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Purpose Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. Summary This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice. Supplementary Information ...

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Associations between trabecular bone score and vertebral fractures in patients with axial spondyloarthritis

Abstract: Similar to individuals with primary osteoporosis, axSpA patients with vertebral fractures have a lower TBS. This suggests that TBS has the potential to predict future vertebral fractures in patients with axSpA.

Cited by 23 publications

References 38 publications

Trabecular Bone Score and Bone Density in Patients With Non-radiographic Axial Spondyloarthritis

Trabecular Bone Score and Bone Density in Patients With Non-radiographic Axial Spondyloarthritis

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

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