Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: The manitoba study

Abstract

The measurement of BMD by dual-energy X-ray absorptiometry (DXA) is the ''gold standard'' for diagnosing osteoporosis but does not directly reflect deterioration in bone microarchitecture. The trabecular bone score (TBS), a novel gray-level texture measurement that can be extracted from DXA images, correlates with 3D parameters of bone microarchitecture. Our aim was to evaluate the ability of lumbar spine TBS to predict future clinical osteoporotic fractures. A total of 29,407 women 50 years of age or older at the time of baseline hip and spine DXA were identified from a database containing all clinical results for the Province of Manitoba, Canada. Health service records were assessed for the incidence of nontraumatic osteoporotic fracture codes subsequent to BMD testing (mean follow-up 4.7 years). Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Osteoporotic fractures were identified in 1668 (5.7%) women, including 439 (1.5%) spine and 293 (1.0%) hip fractures. Significantly lower spine TBS and BMD were identified in women with major osteoporotic, spine, and hip fractures (all p < 0.0001). Spine TBS and BMD predicted fractures equally well, and the combination was superior to either measurement alone ( p < 0.001). Spine TBS predicts osteoporotic fractures and provides information that is independent of spine and hip BMD. Combining the TBS trabecular texture index with BMD incrementally improves fracture prediction in postmenopausal women. ß

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

“…(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.…”

“…(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.…”

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

“…(21) Its primary value beyond BMD is that it may specifically assess some dimensions of vertebral bone microarchitectural texture, which is recognized to be an important determinant of bone strength independent of BMD. ( (17,18) and mCT (35 mm).…”

“…Previously reported precision for TBS ranged between 1.48% (in-house data) and 2.1%. (21) At the Department of Osteoporosis of the University Hospital of Berne, the coefficient of variation for LS BMD measurements assessed in accordance with ISCD recommendations (15 outpatients representative of daily routine with triplicate measurements after repositioning) is 0.90% with a corresponding coefficient of variation of 1.12% for TBS. Thus, the least significant change (LSC) is 2.49% for LS BMD and 3.10% for TBS.…”

“…Furthermore, in this study, combining the TBS with BMD was superior to either TBS or BMD alone, with regard to fracture risk prediction. (21) Based on the positive results in several fracture endpoint trials, aminobisphosphonates have become the mainstay of antiresorptive treatment aimed at reducing the risk of vertebral and nonvertebral, including hip, fractures in postmenopausal women with osteoporosis. (22)(23)(24) As such, yearly infusions of 5 mg of zoledronate (ZOL), a third-generation aminobisphosphonate, showed pronounced antifracture efficacy in the HORIZON fracture endpoint trial, producing significant reductions in new vertebral, nonvertebral, and hip fractures over a 3-year period in postmenopausal women with osteoporosis.…”