Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: the Eastern European TBS study

Abstract

The aim of the study was to assess the clinical performance of the model combining areal bone mineral density (aBMD) at spine and microarchitecural texture (TBS) for the detection of the osteoporotic fracture. The Eastern European Study is a multicenter study (Serbia, Bulgaria, Romania and Ukraine) evaluating the role of TBS in routine clinical practice as a complement to aBMD. All scans were acquired on Hologic Discovery and GE Prodigy densitometers in a routine clinical manner. The additional clinical values of aBMD and TBS were analyzed using a two steps classification tree approach (aBMD followed by TBS tertiles) for all type of osteoporotic fracture (All-OP Fx). Sensitivity, specificity and accuracy of fracture detection as well as the Net Reclassification Index (NRI) were calculated. This study involves 1031 women subjects aged 45 and older recruited in east European countries. Clinical centers were cross-calibrated in terms of BMD and TBS. As expected, areal BMD (aBMD) at spine and TBS were only moderately correlated (r (2) = 0.19). Prevalence rate for All-OP Fx was 26 %. Subjects with fracture have significant lower TBS and aBMD than subjects without fracture (p < 0.01). TBS remains associated with the fracture even after adjustment for age and aBMD with an OR of 1.27 [1.07-1.51]. When using aBMD T-score of -2.5 and the lowest TBS tertile thresholds, both BMD and TBS were similar in terms of sensitivity (35 vs. 39 %), specificity (78 vs. 80 %) and accuracy (64 vs. 66 %). aBMD and TBS combination, induced a significant improvement in sensitivity (+28 %) and accuracy (+17 %) compared to aBMD alone whereas a moderate improvement was observed in terms of specificity (+9 %). The overall combination gain was 36 % as expressed using the NRI. aBMD and TBS combination decrease significantly the number of subjects needed to diagnose from 7 for aBMD alone to 2. In a multi-centre Eastern European cohort, we have shown that the use of TBS in addition to the aBMD permit to reclassified correctly more than one-third of the overall subjects. Furthermore, the number of subjects needed to diagnose fell to 2 subjects. Economical studies have to be performed to evaluate the gain induced by the use of TBS for the healthcare system.

TBS reflects trabecular microarchitecture in premenopausal women and men with idiopathic osteoporosis and low-traumatic fractures

“…Similar results were obtained in another age matched case-control study focusing on osteopenic subjects with vertebral fractures [9]. Vasic et al reported outcomes of the Eastern Europe study (EES), a multi-center study in different European countries that sought to evaluate the role of TBS in routine clinical practice as a complement to BMD and clinical risk factors [26].…”

Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score

“…In postmenopausal women, LS TBS was associated with fracture risk even after adjusting for central DXA BMD and/or FRAX clinical risk factors, such as age, weight, BMI, previous fracture, glucocorticoid use, presence of rheumatoid arthritis (RA), secondary osteoporosis, and high alcohol intake. Several studies have shown that, in postmenopausal women, the combination of LS TBS and BMD slightly improves fracture discrimination compared to BMD alone (25,26,29,35 In unadjusted models, the area under the receiver operating characteristic curve (AUC) was significantly greater for the combination LS BMD þ TBS than for LS BMD alone ( p 5 0.005), but the differences in the adjusted AUCs were not reported.…”

“…BMD at the LS, hip, and the lowest BMD T-score were also associated with fractures, with adjusted ORs ranged from 1.36 to 1.63. The Eastern European TBS study, multicenter, casecontrol trial, evaluated the association of TBS with major osteoporotic fractures in 1031 Caucasian women, aged 45e85 yr, with a BMI between 15 and 35 kg/m 2 (29). Subjects were recruited using the medical record database at 6 centers in East Europe.…”

Clinical Utility of Using Lumbar Spine Trabecular Bone Score to Adjust Fracture Probability: The Manitoba BMD Cohort

“…Previous analyses have shown that lumbar spine TBS is a predictor of fracture risk, independent of BMD, but its inclusion in a multivariate risk model leads to only a small improvement in performance as measured by the AUROC. (7,8,(27)(28)(29)(30)(31) Prior studies have also examined the impact of TBS on risk assessment using NRI; (9,28,30,32) however, the large NRI obtained in some of these studies raises concerns over model miscalibration because other performance metrics were non-significant. (33) The results of the current study are in line with those of Schousboe and colleagues, (34) who reported NRI in fracture cases of þ0.033 (p < 0.005) for TBS-adjusted fracture risk prediction in older men (MrOS), with only a very small net decrease for NRI in men without fracture.…”