Clinical Factors Associated With Trabecular Bone Score
Clinical Factors Associated With Trabecular Bone Score
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DOI：
10.1016/j.jocd.2013.01.006
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发表时间：
2013-07-01
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：
Leslie, William D.;Krieg, Marc-Antoine;Hans, Didier
双能X线骨密度仪(DXA)测量骨密度(BMD)是诊断骨质疏松的参考标准，但不能直接反映骨微结构的恶化。骨小梁评分(TBS)是一种可以从DXA图像中提取的新的灰度纹理测量方法，它可以独立于BMD预测骨质疏松性骨折。我们的目的是确定与基线腰椎TBS相关的临床因素。从包含加拿大马尼托巴省所有临床结果的数据库中，总共确定了29,407名在基线髋关节和脊柱DXA时年龄为50岁的女性。腰椎TBS是在不考虑临床参数和结果的情况下为每个脊柱DXA检查得出的。采用多元线性回归和Logistic回归(最低三分位数与最高三分位数)来确定TBS对其他与骨质疏松相关的危险因素的敏感性。只有一小部分TBS测量(7-11%)可以从BMD测量中得到解释。在多元线性回归和Logistic回归模型中，腰椎TBS降低与最近使用糖皮质激素、既往有重大骨折、类风湿性关节炎、慢性阻塞性肺疾病、高酒精摄入量和较高的体重指数相关。相比之下，最近的骨质疏松症治疗与降低TBS的可能性显著降低有关。在对腰椎或股骨颈骨密度进行调整后，也发现了类似的结果。综上所述，腰椎TBS与许多预测骨质疏松性骨折的危险因素密切相关。还需要进一步的工作来确定腰椎TBS是否可以取代目前用于骨折风险评估的一些临床危险因素。
Dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD) is the reference standard for diagnosing osteoporosis but does not directly reflect deterioration in bone microarchitecture. The trabecular bone score (TBS), a novel grey-level texture measurement that can be extracted from DXA images, predicts osteoporotic fractures independent of BMD. Our aim was to identify clinical factors that are associated with baseline lumbar spine TBS. In total, 29,407 women >= 50 yr at the time of baseline hip and spine DXA were identified from a database containing all clinical results for the Province of Manitoba, Canada. Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Multiple linear regression and logistic regression (lowest vs highest tertile) was used to define the sensitivity of TBS to other risk factors associated with osteoporosis. Only a small component of the TBS measurement (7-11%) could be explained from BMD measurements. In multiple linear regression and logistic regression models, reduced lumbar spine TBS was associated with recent glucocorticoid use, prior major fracture, rheumatoid arthritis, chronic obstructive pulmonary disease, high alcohol intake, and higher body mass index. In contrast, recent osteoporosis therapy was associated with a significantly lower likelihood for reduced TBS. Similar findings were seen after adjustment for lumbar spine or femoral neck BMD. In conclusion, lumbar spine TBS is strongly associated with many of the risk factors that are predictive of osteoporotic fractures. Further work is needed to determine whether lumbar spine TBS can replace some of the clinical risk factors currently used in fracture risk assessment.