Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score

Silva, Barbara C.; Broy, Susan B.; Boutroy, Stéphanie; Schousboe, John T.; Shepherd, John; Leslie, William D.

doi:10.1016/j.jocd.2015.06.008

Cited by 301 publications

(218 citation statements)

References 67 publications

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“…TBS derived from existing DXA scans of the lumbar spine provides information about bone architecture and fracture risk [13,17], which could assist physicians in identifying patients at risk of fracture [22,25]. TBS has also been shown to reflect therapeutic responses to osteoporosis treatments [34][35][36] and could assist in the monitoring of the effectiveness of a therapy.…”

Section: Discussionmentioning

confidence: 99%

“…TBS increases the ability of the Fracture Risk Assessment Tool (FRAX) to categorize fracture risk, and it has been incorporated into the FRAX model as an adjustment factor [20,23,24]. Thus, TBS has been newly included in international guidelines [25], providing an additional tool to identify and improve the characterization of patients at risk for fracture and in need of therapeutic intervention.…”

Section: Introductionmentioning

confidence: 99%

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Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis

McClung¹,

Lippuner²,

Brandi³

et al. 2017

Osteoporos Int

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Summary Trabecular bone score (TBS) assesses bone quality in the lumbar spine using dual-energy X-ray absorptiometry (DXA) scans. In postmenopausal women with osteoporosis, denosumab significantly improved TBS independently of bone mineral density (BMD). This practical technique may have a role in managing patients with osteoporosis. Introduction TBS, a gray-level texture index determined from lumbar spine DXA scans, correlates with bone microarchitecture and enhances assessment of vertebral fracture risk independently of BMD. In the FREEDOM study, denosumab increased BMD and reduced new vertebral fractures in postmenopausal women with osteoporosis. This retrospective analysis explored the effect of denosumab on TBS and the association between TBS and BMD in FREEDOM. Methods Postmenopausal women with lumbar spine or total hip BMD T-score <−2.5 and −4.0 or higher at both sites received placebo or denosumab 60 mg subcutaneously every 6 months. TBS indices were determined from DXA scans at baseline and months 12, 24, and 36 in a subset of 285 women (128 placebo, 157 denosumab) who had TBS values at baseline and ≥1 postbaseline visit. Results Baseline characteristics were comparable between treatment groups; mean (SD) lumbar spine BMD T-score was −2.79 (0.64), and mean (standard deviation [SD]) TBS was 1.200 (0.101) overall. In the placebo group, BMD and TBS increased by ≤0.2% or decreased from baseline at each visit. In the denosumab group, progressive increases from baseline at 12, 24, and 36 months were observed for BMD (5.7, 7.8, and 9.8%) and TBS (1.4, 1.9, and 2.4%). Percentage changes in TBS were statistically significant compared with baseline (p < 0.001) and placebo (p ≤ 0.014). TBS was largely unrelated to BMD, regardless of treatment, either at baseline or for annual changes from baseline (all r 2 ≤ 0.06). Conclusions In postmenopausal women with osteoporosis, denosumab significantly improved TBS independently of BMD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis

McClung¹,

Lippuner²,

Brandi³

et al. 2017

Osteoporos Int

View full text Add to dashboard Cite

show abstract

“…Dedicated software is used to measure the gray level of variation among pixels within the 2D DXA image and differentiate between bone structures with similar areal BMD (a-BMD) but different bone microarchitecture ( Figure 3) (80). TBS is not a direct measure of trabecular microarchitecture, but it has been proved to be associated with vertebral, hip and major osteoporotic fracture risk in postmenopausal women and with hip and major osteoporotic fracture risk in men over 50 years of age (81). Specifically, each SD decline in TBS corresponds to a 20-50% increase in the risk of vertebral, hip and major osteoporotic fractures in postmenopausal women and to a 30-40% increase in risk of hip and major osteoporotic (79).…”

Section: Dxa In Osteoporosismentioning

confidence: 99%

“…Specifically, each SD decline in TBS corresponds to a 20-50% increase in the risk of vertebral, hip and major osteoporotic fractures in postmenopausal women and to a 30-40% increase in risk of hip and major osteoporotic (79). TBS has also been proven to be associated with major osteoporotic fracture risk in postmenopausal women with type 2 DM, thus it may serve as an additional tool for fracture risk assessment in this selected class of patients (81)(82)(83). TBS can also be assessed in other conditions characterized by bone loss (as primary hyper-parathyroidism, rheumatoid arthritis, chronic kidney disease, etc.).…”

Section: Dxa In Osteoporosismentioning

confidence: 99%

Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia

Guerri

Mercatelli

Gómez

et al. 2018

Quant. Imaging Med. Surg.

118

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Bone and muscle are two deeply interconnected organs and a strong relationship between them exists in their development and maintenance. The peak of both bone and muscle mass is achieved in early adulthood, followed by a progressive decline after the age of 40. The increase in life expectancy in developed countries resulted in an increase of degenerative diseases affecting the musculoskeletal system. Osteoporosis and sarcopenia represent a major cause of morbidity and mortality in the elderly population and are associated with a significant increase in healthcare costs. Several imaging techniques are currently available for the non-invasive investigation of bone and muscle mass and quality. Conventional radiology, dual energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound often play a complementary role in the study of osteoporosis and sarcopenia, depicting different aspects of the same pathology. This paper presents the different imaging modalities currently used for the investigation of bone and muscle mass and quality in osteoporosis and sarcopenia with special emphasis on the clinical applications and limitations of each technique and with the intent to provide interesting insights into recent advances in the field of conventional imaging, novel high-resolution techniques and fracture risk.

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“…Elevated TBS closely correlates with better skeletal texture (reflecting healthier microarchitecture), while a low value is connected with weaker texture (damaged microarchitecture) [12][13][14][15][16][17]. Recent studies have proved that TBS may be a useful adjunct to BMD in order to predict fragility fractures in primary osteoporosis [13,18], and it provides the promise of potential utility in secondary osteoporosis [19].…”

Section: Introductionmentioning

confidence: 99%

The Role of Trabecular Bone Score and Hip Geometry in Thalassemia Major: A Neural Network Analysis

Baldini¹,

Grossi²,

Cappellini³

et al. 2017

Br J Res

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Osteopathy in thalassemia is a very heterogeneous condition; severity depends on multiple factors, interacting through nonlinear mechanisms. Classic statistics have limitations when applied to the study of such highly complex relationships. Currently, an alternative approach of analysis is represented by the artificial neural networks (ANNs), powerful mathematical tools, increasingly applied to analyze multifactorial databases, as considered more appropriate than classic statistics. We adopted this specialized mathematical method to 76 thalassemia major (TM) patients. In all of them dual energy X-ray absorptiometry (DXA) was performed to measure bone mineral density, and two recent developments were included: trabecular bone score, evaluating bone microarchitecture, and hip structural analysis, evaluating hip geometry. The relationships between bone status and endocrine, hematologic, and clinical parameters were investigated. Using a particular ANN (Auto Contractive Map algorithm), the strength of inter-variable association was defined and a connectivity map generated, visually representing the main connections among the entered variables. Iron status indices (ferritin, liver iron concentration) emerged as the most important variables, dividing the map into two sectors, with parameters indicating satisfactory bone condition in the upper, those indicating poor condition in the lower, near the variable "fractures". The Auto Contractive Map highlighted the key role of bone quantity, bone geometry, and microarchitecture in defining thalassemic bone condition. Among numerous available indices, high femoral bone mineral density and low cross-sectional moment of inertia emerged as the gold standard to classify thalassemic patients for prognostic and therapeutic purposes.

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Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score

Cited by 301 publications

References 67 publications

Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis

Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis

Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia

The Role of Trabecular Bone Score and Hip Geometry in Thalassemia Major: A Neural Network Analysis

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