Trabecular Bone Score Reference Values for Children and Adolescents According to Age, Sex, and Ancestry.
Trabecular Bone Score Reference Values for Children and Adolescents According to Age, Sex, and Ancestry.
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DOI：
10.1002/jbmr.4520
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发表时间：
2022-04
影响因子：
6.2
通讯作者：
Zemel, Babette S.
中科院分区：
文献类型：
--
作者：
Kalkwarf, Heidi J.;Shepherd, John A.;Hans, Didier;Rodriguez, Elena Gonzalez;Kindler, Joseph M.;Lappe, Joan M.;Oberfield, Sharon;Winer, Karen K.;Zemel, Babette S.
小梁骨评分（TBS）用于成人骨折预测，但其在儿童中的效用受到缺乏适当参考值的限制。我们的目的是为5至20岁的年轻人制定年龄、性别和人口血统的TBS参考范围。我们还研究了身高、BMI和TBS之间的关系，TBS与腰椎区域骨密度（aBMD）和骨矿物质表观密度（BMAD）Z评分之间的一致性，TBS Z评分随时间的变化，以及TBS测量的精确度。我们对来自儿童期骨矿物质密度研究（BMDCS）的脊柱DXA扫描进行了二次分析，BMDCS是在5个美国中心评估的健康儿童（n=2014）的混合纵向队列。TBS是使用专用TBS算法推导的，该算法考虑了组织厚度而不是BMI。TBS增加，只有在相应的青春期发育的年龄，女性比男性更早增加。非裔美国人和非裔美国人之间的TBS没有差异。我们提供了性别特异性TBS参考范围和LMS值，用于按年龄和平均值计算TBS Z评分，并提供了SD，用于按青春期阶段计算Z评分。在某些年龄，TBS Z分数与身高Z分数呈正相关。TBS Z评分仅解释脊柱aBMD和BMAD Z评分变异的27%和17%。追踪6年的TBS Z评分（r=0.47）低于aBMD或BMAD Z评分（r=0.74 - 0.79），TBS的精密度误差（2.87%）大于aBMD（0.85%）和BMAD（1.22%）。总之，TBS Z评分提供了与脊柱aBMD和BMAD Z评分不同的信息。我们在特征良好的儿科队列中稳健的TBS参考范围和精确误差估计为使用TBS进行临床评估以及确定其在预测儿童和青少年骨脆性方面的价值提供了重要工具。
Trabecular bone score (TBS) is used for fracture prediction in adults, but its utility in children is limited by absence of appropriate reference values. We aimed to develop reference ranges for TBS by age, sex and population ancestry for youth ages 5 to 20 years. We also investigated the association between height, BMI and TBS, agreement between TBS and lumbar spine areal bone mineral density (aBMD) and bone mineral apparent density (BMAD) Z-scores, tracking of TBS Z-scores over time, and precision of TBS measurements. We performed secondary analysis of spine DXA scans from the Bone Mineral Density in Childhood Study (BMDCS), a mixed longitudinal cohort of healthy children (n=2014) evaluated at 5 U.S. centers. TBS was derived using a dedicated TBS algorithm accounting for tissue thickness rather than BMI. TBS increased only during ages corresponding to pubertal development with an earlier increase in females than males. There were no differences in TBS between African Americans and non-African Americans. We provide sex-specific TBS reference ranges and LMS values for calculation of TBS Z-scores by age and means and SD for calculation of Z-scores by pubertal stage. TBS Z-scores were positively associated with height Z-scores at some ages. TBS Z-scores explained only 27% and 17% of the variance of spine aBMD and BMAD Z-scores. Tracking of TBS Z-scores over 6 years was lower (r=0.47) than for aBMD or BMAD Z-scores (r=0.74 to 0.79), and precision error of TBS (2.87%) was greater than for aBMD (0.85%) and BMAD (1.22%). In sum, TBS Z-scores provide information distinct from spine aBMD and BMAD Z-scores. Our robust reference ranges for TBS in a well-characterized pediatric cohort and precision error estimates provide essential tools for clinical assessment using TBS, and determination of its value in predicting bone fragility in childhood and adolescence.
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