Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density in Postmenopausal Women: Results From the National Osteoporosis Risk Assessment

Siris, Ethel S.; Miller, Paul D.; Barrett‐Connor, Elizabeth; Faulkner, Kenneth G.; Wehren, Lois E.; Abbott, Thomas A.; Berger, Marc L.; Santora, Arthur C.; Sherwood, Louis M.

doi:10.1097/00006254-200204000-00018

Cited by 286 publications

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“…Epidemiological studies have demonstrated that a significant number of individuals with incident osteoporotic fractures have BMD values above the WHO diagnostic threshold of osteoporosis (T-score≥−2.5) [9][10][11][12]. Findings of a recent study indicate that at any given BMD T-score, the risk of incident vertebral, non-vertebral, and any fracture depended heavily on prevalent radiographic vertebral fracture status.…”

Section: Discussionmentioning

confidence: 99%

Spine radiographs to improve the identification of women at high risk for fractures

et al. 2008

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Summary In women older than 60 years with clinical risk factors for osteoporosis but without osteoporosis based on bone mineral density (T-score≥−2.5), a systematic survey with X-rays of the spine identified previously unknown vertebral deformities in 21% of women. Introduction This study determines the prevalence of vertebral deformities in elderly women with clinical risk factors for osteoporosis but with BMD values above the threshold for osteoporosis (T-score≥−2.5). Methods Bisphosphonate naïve women older than 60 years attending 35 general practices in the Netherlands with ≥2 clinical risk factors for osteoporosis were invited for BMD measurement (DXA). In women with T-score≥−2.5 at both spine and the hips, lateral radiographs of the thoracic and lumbar spine were performed. Results Of 631 women with a DXA measurement, 187 (30%) had osteoporosis (T-score < −2.5 at the spine or the hip). Of the remaining 444 women with T-score ≥−2.5 at both spine and hip, 387 had additional spine radiographs, of whom 80 (21%) had at least one vertebral deformity. Conclusion In elderly women with clinical risk factors for osteoporosis but BMD T-score ≥ −2.5, addition of spine radiographs identified vertebral deformities in 21% (95% CI: 17-25). Since these women are at risk of future fractures, antiosteoporotic treatment should be considered.Osteoporos Int

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Section: Discussionmentioning

confidence: 99%

Spine radiographs to improve the identification of women at high risk for fractures

et al. 2008

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“…This approach may be especially useful in individuals with BMD values in the osteopenic range. This is of interest, since most individuals with fragility fractures will have BMD values not in the osteoporotic range but rather in the osteopenic or even normal range (48,49). This observation could be explained by other aspects of bone quality, such as bone microarchitecture, or even by readily assessable clinical risk factors that increase fracture risk independent of the BMD measurement.…”

Section: Conclusion -Trabecular Bone Score: Facts and Futurementioning

confidence: 99%

Trabecular bone score: perspectives of an imaging technology coming of age

Silva

Bilezikian

2014

Arq Bras Endocrinol Metab

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The trabecular bone score (TBS) is a new method to describe skeletal microarchitecture from the dual energy X-ray absorptiometry (DXA) image of the lumbar spine. While TBS is not a direct physical measurement of trabecular microarchitecture, it correlates with micro-computed tomography (µCT) measures of bone volume fraction, connectivity density, trabecular number, and trabecular separation, and with vertebral mechanical behavior in ex vivo studies. In human subjects, TBS has been shown to be associated with trabecular microarchitecture and bone strength by high resolution peripheral quantitative computed tomography (HRpQCT). Cross--sectional and prospective studies, involving a large number of subjects, have both shown that TBS is associated with vertebral, femoral neck, and other types of osteoporotic fractures in postmenopausal women. Data in men, while much less extensive, show similar findings. TBS is also associated with fragility fractures in subjects with secondary causes of osteoporosis, and preliminary data suggest that TBS might improve fracture prediction when incorporated in the fracture risk assessment system known as FRAX. In this article, we review recent advances that have helped to establish this new imaging technology. Arq Bras Endocrinol Metab. 2014;58(5):493-503 Keywords Trabecular bone score; osteoporosis; fracture risk; bone mineral density; microarchitecture RESUMO TBS (do inglês, "trabecular bone score") é um novo método que estima a microarquitetura óssea a partir de uma imagem de densitometria óssea (DXA) da coluna lombar. Apesar de o TBS não ser uma medida física direta da microarquitetura trabecular, ele correlaciona-se com o volume ósseo, densidade da conectividade trabecular, número de trabéculas e separação trabecular medidos por microtomografia computadorizada (µCT), e com medidas mecânicas da resistência óssea vertebral em estudos ex vivo. Estudos em humanos confirmaram que o TBS associa-se a microarquitetura trabecular e resistência óssea medidas por tomografia computadorizada quantitativa periférica de alta resolução (HRpQCT). Estudos transversais e prospectivos, envolvendo um grande número de indivíduos, mostraram que o TBS é associado com fratura vertebral, de colo de fêmur e com outros tipos de fraturas osteoporóticas em mulheres na pós-menopausa. Dados em homens, apesar de escassos, mostram resultados semelhantes. Além disso, o TBS foi associado a fraturas por fragilidade em indivíduos com diversas causas secundárias de osteoporose e, dados preliminares, sugerem que o uso do TBS pode melhorar a previsão de fratura quando incorporado ao sistema de avaliação de risco de fratura (FRAX). Este artigo faz uma revisão de avanços recentes que têm ajudado a estabelecer esse novo mé-todo de imagem. Arq Bras Endocrinol Metab. 2014;58(5):493-503 Descritores

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“…The World Health Organization (WHO) defines osteoporosis on the basis of reduced bone mineral density (BMD) (WHO, 1994). Low BMD, one of the strongest risk factors for fracture, can easily be determined by dualenergy X-ray absorptiometry (DXA) and used to predict the risk of fractures in elderly women (Cummings et al, 1993;Marshall et al, 1996;Siris et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population

Salminen

Sääf

et al. 2005

Eur J Clin Nutr

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Objective: To investigate the relationship between osteoporosis and nutritional status as determined by the Mini-Nutritional Assessment (MNA). Design: A cross-sectional study. Setting: Stockholm, Sweden. Subjects: A total of 351 elderly free-living women (mean age 7372.3 years). Methods: MNA (range 0-30 points; o17 indicates malnutrition, 17.5-23.5 risk of malnutrition and X24 well nourished), measurements of bone mineral density of the left hip and lumbar spine using Hologic QDR 4500, and of the heel using Calscan DEXA-T. Results: The median MNA score was 27 (range 12.5-30). One woman was classified as malnourished and 7.4% were at risk of malnutrition. Osteoporosis of the femoral neck was observed in 22% and a fracture after the age of 50 was reported by 31% of the participants. The following items in the MNA questionnaire exhibited an increased risk of having osteoporosis in the femoral neck and/or total hip: an MNA score of o27 (odds ratio (OR) ¼ 2.09; CI ¼ 1.14-3.83); a mid-arm circumference of less than 28 cm (OR ¼ 2.97; CI ¼ 1.29-6.81); and regular use of more than 3 drugs each day (OR ¼ 2.12; CI ¼ 1.00-4.50). A body weight of more than 70 kg exhibited a decreased risk of having osteoporosis (OR ¼ 0.31; CI ¼ 0.14-0.70). Conclusions: In general, the nutritional status was good in this population of free-living elderly women. Nevertheless, half of the women who displayed an MNA score o27 points had a twofold increased risk of having osteoporosis.

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Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density in Postmenopausal Women: Results From the National Osteoporosis Risk Assessment

Cited by 286 publications

References 0 publications

Spine radiographs to improve the identification of women at high risk for fractures

Spine radiographs to improve the identification of women at high risk for fractures

Trabecular bone score: perspectives of an imaging technology coming of age

Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population

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