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

Muschitz, Christian; Kocijan, Roland; Haschka, Judith; Pahr, Dieter H.; Kaider, Alexandra; Pietschmann, Péter; Hans, Didier; Muschitz, Gabriela; Fahrleitner‐Pammer, Astrid; Resch, Heinrich

doi:10.1016/j.bone.2015.06.007

Cited by 128 publications

(68 citation statements)

References 35 publications

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“…In particular, using disarticulated vertebra, TBS was shown to be a strong predictor of many trabecular microarchitecture parameters including bone volume fraction, connectivity, trabecular spacing, trabecular thickness, and trabecular number. (1) Silva and colleagues (2) reported strong correlations of spine TBS and high-resolution QCT bone microarchitecture parameters of the radius among postmenopausal women with primary hyperthyroidism, whereas Muschitz and colleagues (17) reported strong correlations between spine TBS and calculated mCT bone microarchitecture parameters of transiliac bone biopsies of men and premenopausal women with idiopathic osteoporosis. However, none of these studies examined whether or not the associations of TBS with microarchitectural parameters vary by BMI, lean tissue mass, or fat tissue mass.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Trabecular Bone Score and Lumbar Spine Volumetric BMD Is Attenuated Among Older Men With High Body Mass Index

Langsetmo

Ensrud

et al. 2016

Journal of Bone and Mineral Research

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Trabecular bone score (TBS) has been proposed as a dual-energy X-ray absorptiometry (DXA) derived measure of underlying quality of trabecular bone; however, TBS is not considered valid for those with body mass index (BMI) >37 kg/m2. Our objective was to determine the association between TBS and lumbar spine (trabecular) volumetric BMD (LS-VBMD) and to examine whether the association varied by BMI and body composition among older men below this clinical threshold. We used regression models to study 3479 men age ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) study who had TBS from spine DXA scans, LS-VBMD from central quantitative computed tomography, measures of trunk fat and lean mass from DXA, and BMI <37kg/m2. TBS was categorized as normal (n = 925), partially degraded (n = 1747), and degraded (n = 807). TBS was inversely related to BMI, trunk fat mass, and trunk lean mass (all p< 0.001). The relationship between TBS and LS-VBMD was nonlinear with magnitude of effect (slope of regression line using standardized variables) ranging from 0.07 (95% CI, −0.02 to 0.15) among those with degraded TBS up to 0.71 (95% CI, 0.54 to 0.89) among those with normal TBS. The relationship was still nonlinear after adjusting for age, clinical site, and either BMI, trunk lean mass, or trunk fat mass. The magnitude of effect relating TBS and LS-VBMD also decreased with increasing BMI (interaction, p = 0.090) and increasing trunk lean mass (interaction, p = 0.001), but not with increasing trunk fat mass (interaction, p = 0.224). In summary, the strength of the association between TBS and LS-VBMD among older men was variable and dependent on BMI and body composition, particularly trunk lean mass. The clinical utility of TBS among older men may be somewhat limited among men with high BMI or high trunk lean mass.

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Section: Discussionmentioning

confidence: 99%

The Association Between Trabecular Bone Score and Lumbar Spine Volumetric BMD Is Attenuated Among Older Men With High Body Mass Index

Langsetmo

Ensrud

et al. 2016

Journal of Bone and Mineral Research

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“…The DXA scans of vertebrae L1-L4 obtained to assess lumbar spine BMD can also be used to generate TBS, thereby producing complementary skeletal information from the same examination [6]. TBS has been shown to be significantly associated with direct measurements of bone microarchitecture and mechanical behavior [5,[8][9][10] and is predictive of current [6,[11][12][13][14][15][16] and future [17][18][19] fragility fractures in postmenopausal women with primary osteoporosis [19,20]. TBS can also be used to assess fracture risk in patients with specific causes of secondary osteoporosis such as hyperparathyroidism, diabetes, and glucocorticoid treatment [21,22].…”

Section: Introductionmentioning

confidence: 99%

Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis

McClung¹,

Lippuner²,

Brandi³

et al. 2017

Osteoporos Int

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Summary Trabecular bone score (TBS) assesses bone quality in the lumbar spine using dual-energy X-ray absorptiometry (DXA) scans. In postmenopausal women with osteoporosis, denosumab significantly improved TBS independently of bone mineral density (BMD). This practical technique may have a role in managing patients with osteoporosis. Introduction TBS, a gray-level texture index determined from lumbar spine DXA scans, correlates with bone microarchitecture and enhances assessment of vertebral fracture risk independently of BMD. In the FREEDOM study, denosumab increased BMD and reduced new vertebral fractures in postmenopausal women with osteoporosis. This retrospective analysis explored the effect of denosumab on TBS and the association between TBS and BMD in FREEDOM. Methods Postmenopausal women with lumbar spine or total hip BMD T-score <−2.5 and −4.0 or higher at both sites received placebo or denosumab 60 mg subcutaneously every 6 months. TBS indices were determined from DXA scans at baseline and months 12, 24, and 36 in a subset of 285 women (128 placebo, 157 denosumab) who had TBS values at baseline and ≥1 postbaseline visit. Results Baseline characteristics were comparable between treatment groups; mean (SD) lumbar spine BMD T-score was −2.79 (0.64), and mean (standard deviation [SD]) TBS was 1.200 (0.101) overall. In the placebo group, BMD and TBS increased by ≤0.2% or decreased from baseline at each visit. In the denosumab group, progressive increases from baseline at 12, 24, and 36 months were observed for BMD (5.7, 7.8, and 9.8%) and TBS (1.4, 1.9, and 2.4%). Percentage changes in TBS were statistically significant compared with baseline (p < 0.001) and placebo (p ≤ 0.014). TBS was largely unrelated to BMD, regardless of treatment, either at baseline or for annual changes from baseline (all r 2 ≤ 0.06). Conclusions In postmenopausal women with osteoporosis, denosumab significantly improved TBS independently of BMD.

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“…6–8 TBS has been shown to predict fracture incidence independent of aBMD and clinical risk factors and has been validated for use in the FRAX fracture prediction model. 7,9,10 As such it has been now approved by medical societies for clinical use (e.g.…”

Section: Introductionmentioning

confidence: 99%

Effects of Teriparatide, Denosumab, or Both on Spine Trabecular Microarchitecture in DATA-Switch: a Randomized Controlled Trial

Tsai¹,

Jiang²,

Lee³

et al. 2017

Journal of Clinical Densitometry

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In postmenopausal women, 2-years of combined teriparatide and denosumab increases bone mineral density (BMD) more than either drug alone and switching from either combination or teriparatide to denosumab for an additional 2-years further increases BMD. Conversely switching from denosumab to teriparatide results in transient bone loss. The effects of these interventions on spine microarchitecture are unknown. In the DATA and DATA-Switch studies, 94 postmenopausal osteoporotic women were randomized to receive 24-months of teriparatide (20-μg-daily), denosumab (60-mg-every-6-months), or both. Then, women originally assigned to 24-months of teriparatide received 24-months of denosumab whereas subjects originally randomized to 24-months of denosumab received 24-months of teriparatide. Subjects who received both drugs received an additional 24-months of denosumab alone. Spine trabecular bone score (TBS, a gray-level textural assessment of bone microarchitecture) was measured blinded from treatment groups using images from 2-dimensional DXA spine scans at 0, 12, 24, 30, 36, and 48 months in 65 women who had PA spine DXA images suitable for TBS analysis. After 24 months, TBS increased by 2.7±4.7% in the teriparatide group (P=0.009 versus baseline), by 1.8±5.0% in the denosumab group (P=0.118 versus baseline), and by 4.5±6.7% in the combination group (P=0.017 versus baseline), with no significant between-group differences. In the 6-months after treatments were switched (months 24–30), TBS continued to increase in the combination-to-denosumab and teriparatide-to-denosumab groups but decreased by −1.1±4.0% in the denosumab-to-teriparatide group (P<0.05 versus other groups). After 48 months, compared to month 0, TBS increased by 5.1±5.8% in the teriparatide-to-denosumab group, by 3.6±4.2% in the denosumab-to-teriparatide group, and by 6.1±4.7% in the combination-to-denosumab group (P<0.001 versus baseline for all groups, P=NS for between group differences). Switching from teriparatide-to-denosumab also increases spine TBS. Conversely, switching from denosumab-to-teriparatide transiently degraded spine trabecular microarchitecture, the clinical consequences of which require further study.

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

Cited by 128 publications

References 35 publications

The Association Between Trabecular Bone Score and Lumbar Spine Volumetric BMD Is Attenuated Among Older Men With High Body Mass Index

The Association Between Trabecular Bone Score and Lumbar Spine Volumetric BMD Is Attenuated Among Older Men With High Body Mass Index

Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis

Effects of Teriparatide, Denosumab, or Both on Spine Trabecular Microarchitecture in DATA-Switch: a Randomized Controlled Trial

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