Association of Trabecular Bone Score (TBS) with Incident Fractures in Older Men

小梁骨评分 (TBS) 与老年男性骨折的关联

• 批准号: 8616927
• 负责人: JOHN Torkild SCHOUSBOE
• 金额: $ 23.35万
• 依托单位: PARK NICOLLET INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8616927
• 关键词: Age; Ancillary Study; Biology; Biopsy; Bone Density; Calibration; Clinical; Cohort Studies; Computer software; Densitometry; Discrimination; Distal; Elderly; Foundations; Fracture; Goals; Gonadal Steroid Hormones; Hip Fractures; Hip region structure; Hormones; Image; Individual; Lateral; Linear Models; Logistic Regressions; MRI Scans; Measures; Metabolic; Methods; Modeling; Morbidity - disease rate; Neck; Osteoporosis; Participant; Performance; Population; Prevention therapy; Probability; Radial; Reporting; Resolution; Risk; Risk Assessment; Risk Factors; Scanning; Signal Transduction; Spinal Fractures; Structure; Testing; Therapeutic Agents; Time; Vertebral column; Visit; Woman; World Health Organization; X-Ray Computed Tomography; bone; bone strength; bone turnover; calcification; clinical care; clinical practice; clinical risk; follow-up; high risk; humerus; improved; indexing; inflammatory marker; innovation; male; men; modifiable risk; mortality; older men; osteoporosis with pathological fracture; public health relevance; response; screening; spine bone structure; statistics; substantia spongiosa; success

Project Summary/Abstract Fractures related to osteoporosis are an important cause of morbidity, and in the case of hip fractures, of mortality in the older male population. Since osteoporosis is asymptomatic until a fracture occurs, successful reduction of the societal burden of fractures in men will require that strategies that can identify the subset of men who are at high risk of suffering a fracture, and who should be treated to reduce that risk. Current prediction models have had only partial success achieving this goal, and models incorporating new aspects of bone biology such as bone microstructure are needed to improve fracture prediction in men. In order to be practically applicable to screening a large subset of the overall population as older men represent, such measures need to inexpensive, practical, and easy to implement in clinical practice. Trabecular Bone Score (TBS), a surrogate measure of trabecular microarchitecture, can be easily measured on spine bone density scans (that are routinely done as part of bone density tests) simultaneously as spine bone density is measured. TBS has been shown to be a predictor of major osteoporotic, hip, and clinical vertebral fractures in women, but how well it predicts fractures in men has never been tested. Predictors of changes of TBS over time also have not been explicated. Since TBS is driven by that component of bone (trabecular) with high metabolic activity, there is the possibility that TBS could be a more sensitive indicator of changes in bone strength than areal BMD of the spine (which is often confounded by degenerative changes and aortic calcification) or of the hip (which is mostly cortical bone). Moreover, preliminary evidence from one trial suggests that TBS significantly improves with treatment with at least one therapeutic agent (denosumab), and there is the possibility that TBS could be a more sensitive indicator of response to pharmacologic fracture prevention therapy than other currently available measures. In this ancillary study to the main Osteoporotic Fractures in Men (MrOS) study, and in response to PA-11-261, we propose to measure TBS on the spine bone density scans obtained on 5,994 participants at the baseline visit and 4,485 men attending the second study visit. Our specific aims are; 1) Test the hypotheses that TBS is independently associated with incident hip, radiographic vertebral, and major osteoporotic fractures (clinically evident fractures of the hip, spine, proximal humerus, or distal radius); 2) Test the hypothesis that the addition of TBS to fracture prediction models in older men improves their discrimination of those who will have a fracture from those who will not; and 3) Determine predictors of changes of TBS score between MrOS visits 1 and 2. Establishing the clinical utility of TBS in fracture risk assessment in men will lay the foundation for application in clinical practice to improve fracture prediction and reduce the societal burden of osteoporotic fractures in men.

项目摘要/摘要 与骨质疏松有关的骨折是发病率的重要原因，在 老年男性死亡率的髋部骨折。由于骨质疏松症无症状直到 发生骨折，成功减轻男性骨折的社会负担将要求 可以识别有骨折高风险的男性子集的策略，并且 应该对待谁来降低这种风险。当前的预测模型只有部分 成功实现了这一目标，并结合了骨生物学的新方面，例如 需要骨微观结构来改善男性骨折预测。为了实际上 适用于筛选大量总人口，因为老年男性代表 在临床实践中，措施需要廉价，实用且易于实施。小梁 骨评分（TBS）是小梁微体系结构的替代度量，很容易 在脊柱骨密度扫描中测量（通常是作为骨密度测试的一部分进行的） 同时测量脊柱骨密度。 TBS已被证明是 女性的主要骨质疏松性，髋关节和临床椎骨骨折，但预测如何 男性骨折从未受过测试。 随着时间的推移，TBS变化的预测因素尚未阐明。因为TBS是 由具有高代谢活性的骨头（小梁）的组成部分驱动，有可能 TBS可能是骨强度变化的更敏感的指标 脊柱（通常被退化性变化和主动脉钙化混淆）或臀部 （主要是皮质骨）。此外，一个试验的初步证据表明TBS 用至少一种治疗剂（Denosumab）的治疗可显着改善，并在那里 TBS可能是对药理学反应的更敏感指标的可能性 与当前可用的措施相比，预防断裂疗法。 在这项对男性（MROS）研究中主要骨质疏松性骨折的辅助研究中，并回应 至PA-11-261，我们建议在5,994的脊柱骨密度扫描上测量TBS 基线访问的参与者和4,485名参加第二次研究访问的男子。我们的具体 目的是； 1）检验TBS与入射髋关节独立相关的假设， 射线照相椎骨和主要骨质疏松性骨折（髋关节的临床明显骨折， 脊柱，肱骨近端或远端半径）； 2）检验将TBS添加到的假设 老年男性中的断裂预测模型改善了他们对那些将拥有的人的歧视 那些不会的人骨折； 3）确定TBS分数变化的预测指标 MROS访问1和2。在男性中建立TBS骨折风险评估中的临床实用性 将奠定在临床实践中的应用，以改善断裂预测和 减轻男性骨质疏松性骨折的社会负担。