Trabecular Bone Score (TBS) Predicts Fracture in Ankylosing Spondylitis: The Manitoba BMD Registry

Richards, Ceri; Hans, Didier; Leslie, William D.

doi:10.1016/j.jocd.2020.01.003

Cited by 31 publications

(23 citation statements)

References 31 publications

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“…In a cross-sectional study of 255 patients with axSpA, we found that low TBS was associated with prevalent vertebral fracture, whereas lumbar spine BMD was not and that TBS showed better discriminatory values for prevalent vertebral fracture than total hip BMD (67). In addition, Richards et al reported that baseline TBS independently predicted major osteoporotic and clinical vertebral fractures in 188 patients with AS, independent of Fracture Risk Assessment Tool scores (70). This finding suggests that TBS could be used as a useful method for incident fracture prediction.…”

Section: Trabecular Bone Scorementioning

confidence: 98%

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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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Section: Trabecular Bone Scorementioning

confidence: 98%

“…A few studies on the association between TBS and the risk of fracture in axSpA have been reported (59,63,67,70). Caparbo et al studied 73 male AS patients and found an association between low TBS values and the prevalence of vertebral fractures.…”

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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“…AS is a chronic inflammatory form of arthritis involving the axial skeleton (46,47), affecting the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. It has been proposed that the sites of attachment of the ligaments or tendons to the bone, known as entheses, are the major target of the inflammatory, traumatic, and degenerative pathological changes occurring in AS (46)(47)(48). Enthesitis is believed to play a primary role in the ligament calcification process, which leads to pain.…”

Section: Tbs and Ankylosing Spondylitismentioning

confidence: 99%

“…New bone formation, which includes the development of syndesmophytes and ankylosis of the spine, is almost pathognomonic for AS (47)(48)(49)(50)(51).…”

Section: Tbs and Ankylosing Spondylitismentioning

confidence: 99%

“…Since AS mainly affects young men and BMD gives falsely increased values, there is often a delay in prevention and/or treatment of OP in this condition. Therefore, appropriate bone assessment to determine bone strength, microstructure and any ossifications is a must to start correct treatment in routine practice (17,18,(47)(48)(49)(50)(51).…”

Section: Tbs and Ankylosing Spondylitismentioning

confidence: 99%

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What Role Does Trabecular Bone Score Play in Chronic Inflammatory Rheumatic Diseases?

Ruaro¹,

Casabella

Molfetta

et al. 2020

Front. Med.

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Patients suffering from rheumatic inflammatory diseases, e.g., systemic sclerosis, rheumatoid arthritis, and ankylosing spondylitis, are at risk of low bone mass. Dual-energy X-ray Absorptiometry (DXA) is the traditional radiological measurement technique for bone mineral density (BMD). The recently developed trabecular bone score (TBS) enhances the skeletal information provided by standard BMD. It re-analyzes the spatial dynamics of pixel intensity changes in lumbar spine DXA images, defining a quantitative index, characterizing trabecular bone microarchitecture. It has been demonstrated that low TBS values are associated with an increased incidence of fractures in patients with rheumatic diseases. These methods used together for bone damage evaluation can be of value to identify individuals who will potentially fracture. The main scientific literature on the clinical aspects of osteoporosis, including the use of TBS in evaluating this pathology, are herein reported aimed at shedding light on the role trabecular bone score plays in chronic inflammatory rheumatic diseases.

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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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Trabecular Bone Score (TBS) Predicts Fracture in Ankylosing Spondylitis: The Manitoba BMD Registry

Cited by 31 publications

References 31 publications

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

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

What Role Does Trabecular Bone Score Play in Chronic Inflammatory Rheumatic Diseases?

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