Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score
Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score
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DOI：
10.1016/j.jocd.2015.06.008
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发表时间：
2015-07-01
影响因子：
2.5
通讯作者：
Leslie, William D.
中科院分区：
文献类型：
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作者：
Silva, Barbara C.;Broy, Susan B.;Leslie, William D.
双能x线骨密度仪（DXA）测量的骨密度（BMD）是骨质疏松症诊断和治疗的金标准。然而，骨密度只解释了60%-80%的骨强度，而骨密度以外的许多骨骼特征也会影响骨强度和骨折风险。先进的成像模式可以评估这些骨骼特征，但与标准DXA相比，这些技术成本更高，可及性有限。因此，一个主要的挑战是将一种现成的、无创的技术应用到临床实践中，这种技术可以改善骨折风险预测，而不仅仅是标准DXA测量和临床风险因素的结合。为此，研究人员对腰椎DXA图像的灰度纹理指数——骨小梁评分（TBS）进行了研究。国际临床密度测量学会工作组的目的是审查证据并就如何将TBS纳入临床实践提出建议。讨论了TBS在骨折风险评估、治疗启动、治疗监测以及在骨折风险较大的特殊情况下使用TBS的临床应用。在仔细审查了TBS工作组提出的建议和证据后，我们提出了专家小组批准的官方立场。
Bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for the diagnosis and management of osteoporosis. However, BMD explains only 60%-80% of bone strength, and a number of skeletal features other than BMD contribute to bone strength and fracture risk. Advanced imaging modalities can assess some of these skeletal features, but compared to standard DXA, these techniques have higher costs and limited accessibility. A major challenge, therefore, has been to incorporate in clinical practice a readily available, noninvasive technology that permits improvement in fracture-risk prediction beyond that provided by the combination of standard DXA measurements and clinical risk factors. To this end, trabecular bone score (TBS), a gray-level textural index derived from the lumbar spine DXA image, has been investigated. The purpose of this International Society for Clinical Densitometry task force was to review the evidence and develop recommendations on how to incorporate TBS in clinical practice. Clinical applications of TBS for fracture risk assessment, treatment initiation, monitoring of treatment, and use of TBS in special conditions related to greater fracture risk, were addressed. We present the official positions approved by an expert panel following careful review of the recommendations and evidence presented by the TBS task force.