Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism

Abstract

Objective: In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture. Design: We studied 92 PHPT patients (74 females, age 62.1G9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph. Results: PHPT patients had lower TBS (K2.39G1.8) and higher VFx prevalence (43.5%) than controls (K0.98G1.07 and 8.2% respectively, both P!0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1-1.9, PZ0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (C47G44.8,C29.2 G34.1,C49.4G48.7 and C30.2G39.3% respectively, all P!0.0001). Among patients treated conservatively, TBS decreased significantly in those (nZ3) with incident VFx (K1.3G0.3) compared with those without (K0.01G0.9, PZ0.048), while BMD changes were not statistically different (LS 0.3G1.2 vs K0.8G0.9 respectively, PZ0.19; TH 0.4G0.8 vs K0.8G1.4 respectively, PZ0.13 and FN 0.4G0.9 vs K0.8G1.4 respectively, PZ0.14). Conclusions: In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.

Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice

“…Several studies provide support for use of lumbar TBS in the management of asymptomatic primary hyperparathyroidism [75][76][77][78]. Romagnoli et al [77] noted lower TBS in 73 postmenopausal women with primary hyperparathyroidism (29 of them having a documented vertebral fracture) than in 74 age-matched controls.…”

“…Romagnoli et al [77] noted lower TBS in 73 postmenopausal women with primary hyperparathyroidism (29 of them having a documented vertebral fracture) than in 74 age-matched controls. In a study that included both crosssectional and longitudinal components, Eller-Vainicher et al [76] compared 92 patients with primary hyperparathyroidism (74 of them post-menopausal females and the remainder males over age 50 years) and 98 controls with other conditions, consecutively recruited from clinic. Again, TBS was lower in patients with primary hyperparathyroidism than in controls, and was statistically significantly associated with vertebral fracture, even after adjustment for age, gender, BMI and lumbar spine aBMD (adjusted OR = 1.4; 95%CI: 1.1-1.9).…”

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

“…A prospective observational study has also evaluated TBS in patients with PHPT (n = 92; 74 females; mean age 62.7 ± 10.1 years) and 98 control subjects (36). Vertebral fractures were assessed by radiographs.…”

¿Son válidos los criterios quirúrgicos actuales del hiperparatiroidismo primario asintomático?

“…This leads us to suggest the need to include in the indications for surgery for asymptomatic HPT, on the one hand the evaluation of the TBS, and on the other, the carrying out of a gammagraphy of the parathyroids, at least as an optional test. Although the measurement of the TBS is a relatively recent technique 12,13 a number of studies have described its alteration in PHPT 6,[14][15][16] . We should take into account the fact that the values of TBS may have been affected by the morbid obesity from which our patient suffered, as has been mentioned earlier 13 .…”

“…To throw light on this matter a number of position documents have been published [5][6][7][8][9][10] , without there being unanimous agreement [2][3][4]10,11 . Techniques such as bone densitometry help to establish the existence of osteoporosis as a complication 3,6 , and recently a new technique has been introduced, the trabecular bone score (TBS), which is intended to evaluate the integrity and connectivity of the trabeculae of the vertebrae [12][13][14][15] , with some studies having been published which show the early effects of PHPT [14][15][16] . While intervention criteria are a widely used tool when taking a therapeutic decision, on occasion the patient may benefit from surgery in spite of their not strictly meeting these criteria.…”