“Trabecular Bone Score” (TBS): An indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism

Romagnoli, Elisabetta; Cipriani, Cristiana; Nofroni, Italo; Castro, Claudia Lúcia Barros de; Angelozzi, Maurizio; Scarpiello, Addolorata; Pepe, Jessica; Diacinti, Daniele; Piemonte, Sara; Carnevale, Vincenzo; Minisola, Salvatore

doi:10.1016/j.bone.2012.11.041

Cited by 146 publications

(127 citation statements)

References 35 publications

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“…At variance with that study, however, in the present one the years since menopause was not found to be an important parameter to use in combination with TBS to detect patients with fractures. This may be explained by the fact that in this study, but not in the previous one (24), TBS data were adjusted for age and expressed as Z values. This adjustment may probably simplify the clinical use of TBS data.…”

Section: Discussionmentioning

confidence: 99%

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

Eller-Vainicher

Filopanti

Palmieri

et al. 2013

European Journal of Endocrinology

131

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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.

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Section: Discussionmentioning

confidence: 99%

“…Recently, TBS has been found to be more accurate than spinal BMD for identifying PHPT patients at risk for VFx (24) and to be associated with trabecular microarchitecture as assessed by high-resolution peripheral quantitative computed tomography (25).…”

Section: Introductionmentioning

confidence: 99%

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

Eller-Vainicher

Filopanti

Palmieri

et al. 2013

European Journal of Endocrinology

131

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“…The association of vertebral fracture and TBS was examined in a cross-sectional study of 73 postmenopausal women with primary hyperparathyroidism (PHPT) compared to 74 age-matched healthy women (35). While LS BMD and femoral neck BMD were similar between the groups, TBS was significantly lower in subjects with PHPT (1.19 ± 0.10) than in controls (1.24 ± 0.09, p < 0.01).…”

Section: Primary Hyperparathyroidismmentioning

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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“…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 .…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Fernández-SanMillán

et al. 2015

Rev Osteoporos Metab Miner

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SummaryHPTP is a very frequent pathology which often develops asymptomatically. Surgical intervention being the only curative treatment for this disease there are some criteria for the indication of surgery, but these do not always fit the reality of the patient since they are based on clinical complications (osteoporosis, renal insufficiency, urolithiasis, fragility fractures). We present the clinical case of a patient who did not meet any of the requirements for having surgical intervention according to the position documents, and who was operated on after the existence was shown of a deterioration of the trabecular bone structure, determined by the TBS (trabecular bone score) technique, and located in the adenoma using gammagraphy. The possible use of these techniques, not seen in the position documents, to complement the decision regarding surgery, is discussed.

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“Trabecular Bone Score” (TBS): An indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism

Cited by 146 publications

References 35 publications

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

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

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

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

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