Trabecular Bone Score as a Risk Factor of Major Osteoporotic Fracture in Postmenopausal Women: The First Study in Thailand

Abstract

Objectives To compare the trabecular bone score (TBS) between Thai postmenopausal women with and without major osteoporotic fracture, and to determine whether TBS is associated with fracture risk. Methods All postmenopausal women sent for dual-energy X-ray absorptiometry (DXA) at the Police General Hospital were retrospectively recruited. The hospital’s online database and radiographs were reviewed to collect information on underlying disease, medication, previous fractures, bone mineral density, and trabecular bone score. Patients with anti-osteoporotic medication use, skeletal malignancy, fracture from high-energy trauma, and uninterpretable DXA images were excluded. Results A total of 407 Thai postmenopausal women were enrolled. They were divided into 292 women without fractures and 115 women with major osteoporotic fractures. The fracture group was older (73.36 ± 9.95 vs. 66.00 ± 8.58, P < 0.001) and had lower serum 25-hydroxyvitamin D levels (23.28 ± 9.09 vs. 26.44 ± 9.20, P = 0.023). The mean TBS was lower in the fracture group, compared to the non-fracture group (1.244 ± 0.101 vs. 1.272 ± 0.099, P = 0.011). The subgroup analysis resulted in noticeably lower TBS in spine fracture, but not other fracture sites. The odds ratio of fracture was 1.355 ( P = 0.013) for a decrease in one standard deviation of TBS. Conclusions TBS was significantly lower in postmenopausal women having fractures with an odd ratio of 1.355 ( P = 0.013) per SD decrease in TBS. Categorizing by fracture sites, TBS was only found to be noticeably lower in the lumbar spine despite similar lumbar spine bone mineral density.

Current issues in evaluation and management of osteoporosis in Thailand

“…According to EGAT cohort data, one standard deviation (SD) decrease in TBS was associated with approximately 1.3-fold greater risk of vertebral fracture in male. Similarly, in another study of 407 postmenopausal women from Police General Hospital in Bangkok, the odds ratio of fracture was 1.35 for a one SD decrease in TBS [ 76 ]. Additionally, combined low TBS and BMD was found to be associated with a 4-fold increased risk vertebral fracture among 86 patients with thalassemia [ 77 ].…”