Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice
Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice
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DOI：
10.1016/j.jocd.2017.06.019
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发表时间：
2017-07-01
影响因子：
2.5
通讯作者：
Hans, Didier
中科院分区：
文献类型：
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作者：
Shevroja, Enisa;Lamy, Olivier;Hans, Didier
骨质疏松症是一种常见的骨骼疾病，其特征在于低骨量和骨微结构改变，导致骨强度降低，骨折风险增加。在临床实践中，医生可以根据几个风险因素评估患者骨折的风险。一些如年龄，体重和50岁后的骨折史，父母骨折，吸烟状况和酒精摄入量被纳入FRAX，这是一种评估工具，根据个人的风险因素概况估计髋部骨折和主要骨质疏松性骨折的10年概率。骨质疏松症的诊断目前是基于骨矿物质密度（BMD）评估的双能X射线吸收扫描。在BMD的其他广泛公认的局限性中，BMD仅考虑骨的密度并且不能测量骨微结构，为此已经开发了新的技术，例如小梁骨评分（TBS）。TBS是与骨微结构相关的纹理参数，其可以提供未从标准BMD测量捕获的骨骼信息。一些研究已经检验了TBS对预测骨质疏松性骨折的价值。我们的研究旨在总结当前科学文献的综述，重点是骨折风险评估，并介绍其发现和关于如何以及何时使用TBS的结论。现有文献表明，下腰椎TBS与骨折史和新发骨折的发生率相关。该效应在很大程度上与BMD无关，并且足以增强BMD的风险分层。TBS效应也独立于FRAX，对于那些BMD水平接近干预阈值的个体可能具有最大效用。支持使用TBS的临床和科学证据，以及该技术无缝集成到日常工作流程中的能力，使TBS成为医生改善骨质疏松症患者管理的有吸引力和有用的临床工具。进一步的研究正在进行中，有必要进一步澄清TBS在其他特定疾病中的作用。
Osteoporosis is a common bone disease characterized by low bone mass and altered bone microarchitecture, resulting in decreased bone strength with an increased risk of fractures. In clinical practice, physicians can assess the risk of fracture for a patient based on several risk factors. Some such as age, weight, and history of fractures after 50 years of age, parental fracture, smoking status, and alcohol intake are incorporated into FRAX, an assessment tool that estimates the 10-year probability of hip fracture and major osteoporotic fractures based on the individual's risk factors profile. The diagnosis of osteoporosis is currently based on bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry scans. Among other widely recognized limitations of BMD is that BMD considers only the density of the bone and fails in measuring bone microarchitecture, for which novel techniques, such as trabecular bone score (TBS), have been developed. TBS is a texture parameter related to bone microarchitecture that may provide skeletal information that is not captured from the standard BMD measurement. Several studies have examined the value of TBS on predicting osteoporotic fractures. Our study aimed to summarize a review of the current scientific literature with focus on fracture risk assessment and to present both its findings and its conclusions regarding how and when TBS should be used. The existing literature indicates that low lumbar spine TBS is associated with a history of fracture and the incidence of new fracture. The effect is largely independent of BMD and of sufficient magnitude to enhance risk stratification with BMD. The TBS effect is also independent of FRAX, with likely greatest utility for those individuals whose BMD levels lie close to an intervention threshold. The clinical and scientific evidence supporting the use of TBS, with the ability of this technology to be seamlessly integrated into a daily workflow, makes TBS an attractive and useful clinical tool for physicians to improve patient management in osteoporosis. Further research is ongoing and necessary to further clarify the role of TBS in additional specific disorders.