A multicentre, retrospective case-control study assessing the role of trabecular bone score (TBS) in menopausal Caucasian women with low areal bone mineral density (BMDa): Analysing the odds of vertebral fracture
A multicentre, retrospective case-control study assessing the role of trabecular bone score (TBS) in menopausal Caucasian women with low areal bone mineral density (BMDa): Analysing the odds of vertebral fracture
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DOI：
10.1016/j.bone.2009.06.032
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发表时间：
2010-01-01
期刊：
影响因子：
4.1
通讯作者：
Hans, Didier
中科院分区：
文献类型：
--
作者：
Rabier, Benedicte;Heraud, Alain;Hans, Didier
简介：骨小梁评分（TBS）是一个新的参数，通过DXA图像的灰度分析确定。它依赖于骨小梁微结构的平均厚度和体积分数。这是一项初步的病例对照研究，旨在评估TBS单独或联合骨密度（BMDa）在评估椎体骨折中的潜在诊断价值。从441名年龄在50岁至80岁之间的绝经后白人女性的受试者中，我们确定了42名患有骨质疏松相关椎体骨折的女性，并与126例年龄相匹配的无骨折妇女（1例：3例对照）进行比较。主要结局为BMDa和TBS。分别使用Student t检验和Wilcoxon符号秩检验对参数和非参数数据进行组间比较。计算BMDa和TBS每增加一个标准差降低时椎骨骨折的比值比，计算受试者工作曲线下面积（AUC），并进行敏感性分析，以比较BMDa单独使用、TBS单独使用以及BMDa和TBS联合使用。亚组分析进行了专门为妇女骨量减少，并为妇女与T-评分定义的osteoporosis.Results：在所有科目（n=42，126）的重量和体重指数更大，BMDa和TBS都在妇女骨折。TBS每增加一次降低，椎骨骨折的几率为3.20（95%CI，2.01-5.08），BMDa为1.95（1.34-2.84），BMDa + TBS联合为3.62（2.32-5.65）。TBS的AUC大于BMDa（0.746 vs. 0.662，p=0.011）。在BMDa和TBS的等特异性（61.9%）或等敏感性（61.9%）下，TBS + BMDa的敏感性或特异性比单独BMDa或TBS高19.1%或16.7%。在骨质疏松症受试者中（n=11，40）BMDa（p=0.0008）和TBS（p=0.0001）在骨折受试者中较低，（p=0.013），BMDa + TBS组大于BMDa单独组（OR=4.04 [2.35-6.92] vs. 2.43 [1.49-3.95]; AUC=0.835 [0.755-0.897] vs.0.718 [0.627-0.797]，p=0.013）。在骨量减少的受试者中，骨折女性的TBS较低（p=0.0296），但BMDa则不然（p=0.75）。同样，TBS的OR在统计学上大于1.00（2.82，1.27-6.26），但不适用于BMDa（1.12，0.56-2.22），AUC也是如此（p=0.035），但特异性无统计学差异结论：骨小梁评分在骨质疏松症检测和骨折风险评估中是否具有临床应用价值值得进一步研究。(C)2009爱思唯尔公司All rights reserved.
Introduction: The trabecular bone score (TBS) is a new parameter that is determined from grey level analysis of DXA images. It relies on the mean thickness and volume fraction of trabecular bone microarchitecture. This was a preliminary case-control study to evaluate the potential diagnostic value of TBS, both alone and combined with bone mineral density (BMDa), in the assessment of vertebral fracture.Methods: Out of a subject pool of 441 Caucasian, postmenopausal women between the ages of 50 and 80 years, we identified 42 women with osteoporosis-related vertebral fractures, and compared them with 126 age-matched women without any fractures (1 case: 3 controls). Primary outcomes were BMDa and TBS. Inter-group comparisons were undertaken using Student's t-tests and Wilcoxon signed ranks tests for parametric and non-parametric data, respectively. Odds ratios for vertebral fracture were calculated for each incremental one standard deviation decrease in BMDa and TBS, and areas under the receiver operating curve (AUC) calculated and sensitivity analysis were conducted to compare BMDa alone, TBS alone, and the combination of BMDa and TBS. Subgroup analyses were performed specifically for women with osteopenia, and for women with T-score-defined osteoporosis.Results: Across all subjects (n=42, 126) weight and body mass index were greater and BMDa and TBS both less in women with fractures. The odds of vertebral fracture were 3.20 (95% CI, 2.01-5.08) for each incremental decrease in TBS, 1.95 (1.34-2.84) for BMDa, and 3.62 (2.32-5.65) for BMDa + TBS combined. The AUC was greater for TBS than for BMDa (0.746 vs. 0.662, p=0.011). At iso-specificity (61.9%) or iso-sensitivity (61.9%) for both BMDa and TBS, TBS + BMDa sensitivity or specificity was 19.1% or 16.7% greater than for either BMDa or TBS alone. Among subjects with osteoporosis (n=11, 40) both BMDa (p=0.0008) and TBS (p=0.0001) were lower in subjects with fractures, and both OR and AUC (p=0.013) for BMDa + TBS were greater than for BMDa alone (OR=4.04 [2.35-6.92] vs. 2.43 [1.49-3.95]; AUC=0.835 [0.755-0.897] vs.0.718 [0.627-0.797], p=0.013). Among subjects with osteopenia,TBS was lower in women with fractures (p=0.0296), but BMDa was not (p=0.75). Similarly, the OR for TBS was statistically greater than 1.00 (2.82, 1.27-6.26), but not for BMDa (1.12, 0.56-2.22), as was the AUC (p=0.035), but there was no statistical difference in specificity (p=0.357) or sensitivity (p=0.678).Conclusions: The trabecular bone score warrants further study as to whether it has any clinical application in osteoporosis detection and the evaluation of fracture risk. (C) 2009 Elsevier Inc. All rights reserved.