Dual-energy X-ray Absorptiometry Monitoring with Trabecular Bone Score: 2019 ISCD Official Position
Dual-energy X-ray Absorptiometry Monitoring with Trabecular Bone Score: 2019 ISCD Official Position
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DOI：
10.1016/j.jocd.2019.07.006
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发表时间：
2019-10-01
影响因子：
2.5
通讯作者：
Lewiecki, E. Michael
中科院分区：
文献类型：
--
作者：
Krohn, Kelly;Schwartz, Elliott N.;Lewiecki, E. Michael
骨小梁评分（TBS）是一种纹理指数，通过双能X线吸收法评估腰椎图像中的像素灰度变化。它提供了一个间接评估小梁微结构，是一个独立的预测骨折的风险。TBS在监测双膦酸盐和地舒单抗的骨骼效应方面似乎没有临床意义，但可能可用作监测特立哌齐和阿巴帕齐的骨骼效应的组分。TBS的最小显著性变化（LSC）可保守估计为约5.8%（已发表数据中的最大LSC），或通过双能X射线吸收测量设施使用与骨矿物质密度（BMD）精密度评估相同的方法计算BMD LSC。在2019年ISCD职位发展会议上，对现有最佳证据的审查得出结论，TBS在监测抗吸收治疗中的作用尚不清楚，TBS可能用于监测合成代谢治疗。对于接受特立帕肽或阿巴帕肽治疗的患者，TBS的统计学显著性增加可能代表小梁结构的临床有意义的改善。TBS的显著降低可能代表小梁结构的恶化，表明需要进一步的临床评估和治疗策略的可能变化。由于BMD测量骨量和TBS测量骨质，这些测试可以被认为是补充评估骨折风险和治疗反应在适当的患者。
Trabecular bone score (TBS) is a textural index that evaluates pixel gray level variations in the lumbar spine image by dual-energy X-ray absorptiometry. It provides an indirect assessment of trabecular microarchitecture that is an independent predictor of fracture risk. TBS does not appear to be clinically useful to monitor the skeletal effects of bisphosphonates and denosumab, but is potentially useful as a component of monitoring the skeletal effects of teriparatide and abaloparatide. The least significant change (LSC) for TBS can be conservatively estimated to be about 5.8% (the largest LSC in published data) or calculated by a dual-energy X-ray absorptiometry facility using the same methodology that is used for bone mineral density (BMD) precision assessment to calculate BMD LSC. A review of the best available evidence at the 2019 ISCD Position Development Conference concluded that the role of TBS in monitoring antiresorptive therapy is unclear and that TBS is potentially useful for monitoring anabolic therapy. For patients treated with teriparatide or abaloparatide, a statistically significant increase in TBS may represent a clinically meaningful improvement in trabecular structure. A significant decrease of TBS may represent a worsening of trabecular structure, suggesting the need for further clinical assessment and possible change in treatment strategies. Since BMD measures bone quantity and TBS measures bone quality, these tests can be considered complementary in assessing fracture risk and response to therapy in appropriate patients.