A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX
A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX
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DOI：
10.1002/jbmr.2734
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发表时间：
2016-05-01
影响因子：
6.2
通讯作者：
Kanis, John A.
中科院分区：
文献类型：
--
作者：
McCloskey, Eugene V.;Oden, Anders;Kanis, John A.
松质骨评分（TBS）是一种基于腰椎双能X线骨吸收仪（DXA）图像的骨微结构灰度纹理指数。TBS是骨折风险的骨矿物质密度（BMD）非依赖性预测因子。本荟萃分析的目的是确定TBS是否独立于FRAX概率预测骨折风险，并通过调整TBS的FRAX概率来检查其综合性能。我们使用了来自14个前瞻性人群队列中17，809名男性和女性的个人水平数据。基线评估包括TBS和FRAX风险变量，随访期间（平均6.7年）的结果包括严重的腰椎骨折。在每个队列和每个性别中使用扩展的泊松回归模型检查TBS、FRAX概率和骨折风险之间的关联，并表示为风险梯度（GR;风险变量在风险增加方向上每1 SD变化的风险比）。使用来自独立队列（马尼托巴骨密度队列）的调整因子，针对TBS调整FRAX概率。总的来说，当校正年龄和自基线以来的时间时，严重腰椎骨折的TBS GR为1.44（95%置信区间[CI] 1.35 - 1.53），男性和女性相似（p> 0.10）。当额外校正FRAX 10年严重骨质疏松性骨折的概率时，TBS仍然是骨折的显著独立预测因子（GR = 1.32，95%CI 1.24 - 1.41）。TBS的FRAX概率调整导致GR小幅增加（1.76，95% CI 1.65 - 1.87 vs 1.70，95% CI 1.60 - 1.81）。观察到髋部骨折的GR变化较小（FRAX髋部骨折概率GR 2.25 vs. 2.22）。TBS是独立于FRAX的骨折风险的重要预测因子。研究结果支持使用TBS作为FRAX概率的潜在调整，尽管调整的影响仍有待于在临床评估指南的背景下确定。(C)2015年美国骨与矿物质研究学会。
Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. (C) 2015 American Society for Bone and Mineral Research.