Spine Trabecular Bone Score Subsequent to Bone Mineral Density Improves Fracture Discrimination in Women
Spine Trabecular Bone Score Subsequent to Bone Mineral Density Improves Fracture Discrimination in Women
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DOI：
10.1016/j.jocd.2013.05.001
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发表时间：
2014-01-01
影响因子：
2.5
通讯作者：
Binkley, Neil
中科院分区：
文献类型：
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作者：
Krueger, Diane;Fidler, Ellen;Binkley, Neil
双能X线骨密度仪（DXA）测量的骨密度（BMD）用于诊断骨质疏松症和评估骨折风险。然而，DXA不能评价小梁微结构。本研究使用一种新型软件程序（TBS iNsight; Med-Imaps，日内瓦，瑞士）从标准脊柱DXA图像中估计骨纹理（骨小梁评分[TBS]）。我们假设，TBS评估将区分妇女与低创伤骨折。在这项研究中，TBS对429名女性现有研究DXA腰椎（LS）图像的骨折状态进行了盲法。参与者的平均年龄为71.3岁，158例既往骨折。LS BMD与TBS之间的相关性较低（r = 0.28），表明这些参数反映了不同的骨特性。年龄和身体质量指数调整的比值比（OR）范围为1.36至1.63 LS或髋部BMD的歧视妇女低创伤非椎骨和椎骨骨折。TBS显示这些骨折的OR为2.46 - 2.49;在最低BMD T评分调整后，这些仍然具有显著性（OR = 2.38和2.44）。73%的骨折发生在没有骨质疏松症的女性（BMD T评分> -2.5）;这些女性中有72%的TBS评分低于中位数，因此将其适当地归类为风险增加。总之，TBS评估通过评估骨小梁模式和识别椎体或低创伤骨折个体来增强DXA。TBS确定了66-70%的骨折妇女，仅通过BMD未被归类为骨质疏松症。
Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is used to diagnose osteoporosis and assess fracture risk. However, DXA cannot evaluate trabecular microarchitecture. This study used a novel software program (TBS iNsight; Med-Imaps, Geneva, Switzerland) to estimate bone texture (trabecular bone score [TBS]) from standard spine DXA images. We hypothesized that TBS assessment would differentiate women with low trauma fracture from those without. In this study, TBS was performed blinded to fracture status on existing research DXA lumbar spine (LS) images from 429 women. Mean participant age was 71.3 yr, and 158 had prior fractures. The correlation between LS BMD and TBS was low (r = 0.28), suggesting these parameters reflect different bone properties. Age- and body mass index adjusted odds ratios (ORs) ranged from 1.36 to 1.63 for LS or hip BMD in discriminating women with low trauma nonvertebral and vertebral fractures. TBS demonstrated ORs from 2.46 to 2.49 for these respective fractures; these remained significant after lowest BMD T-score adjustment (OR = 2.38 and 2.44). Seventy-three percent of all fractures occurred in women without osteoporosis (BMD T-score > -2.5); 72% of these women had a TBS score below the median, thereby appropriately classified them as being at increased risk. In conclusion, TBS assessment enhances DXA by evaluating trabecular pattern and identifying individuals with vertebral or low trauma fracture. TBS identifies 66-70% of women with fracture who were not classified with osteoporosis by BMD alone.