Trabecular Bone Score Reference Values for Children and Adolescents According to Age, Sex, and Ancestry

Kalkwarf, Heidi J.; Shepherd, John; Hans, Didier; Rodríguez, Elena González; Kindler, Joseph M.; Oberfield, Sharon E.; Winer, Karen K.; Zemel, Babette S.

doi:10.1002/jbmr.4520

Cited by 15 publications

(12 citation statements)

References 34 publications

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“…The Bone Mineral Density in Childhood Study (BMDCS) provides the much needed reference norms for TBS from a large representative sample of American youth measured using Hologic DXA equipment. (16) The data clearly demonstrate that spine microarchitecture evolves during the first two decades. TBS is stable until onset of puberty, begins to increase earlier in females than males, and continues to increase in both sexes into later stages of puberty.…”

Section: Discussionmentioning

confidence: 85%

“…Pediatric TBS values derived using the current commercially available TBS BMI algorithm are systematically higher than the TBS TH values calculated using pre‐release software employed in the BMDCS study. ( 16 ) Therefore, the BMDCS TBS TH norms are not appropriate reference values to use when analyzing TBS BMI results. The differences would result in an overestimation of TBS and potentially create false reassurance about spine microarchitecture.…”

Section: Discussionmentioning

confidence: 99%

“…The ageand sex-specific Z-scores for both TBS TH and TBS BMI were generated using BMDCS TBS TH norms. (16) All statistical analyses were performed using Stata 13 (Stata-Corp LP, College Station, TX, USA). All tests were two sided and conducted at a = 0.05 level of significance.…”

Section: Methodsmentioning

confidence: 99%

“…The age‐ and sex‐specific Z ‐scores for both TBS TH and TBS BMI were generated using BMDCS TBS TH norms. ( 16 )…”

Section: Methodsmentioning

confidence: 99%

“…Published pediatric norms for TBS from a representative cohort of 2014 healthy youth (ages 5 to 20 years) provide insight into development of TBS through childhood and adolescence. ( 16 ) TBS values specific for age and sex were generated from secondary analyses of DXA scans of the spine from the Bone Mineral Density in Childhood Study (BMDCS) using a pre‐release version of TBS TH . The TBS reference data from the BMDCS study could serve as a valuable yardstick for evaluating the skeletal effects of chronic disease in younger patients.…”

Section: Introductionmentioning

confidence: 99%

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Trabecular Bone Score (TBS) Varies with Correction for Tissue Thickness Versus Body Mass Index: Implications When Using Pediatric Reference Norms

Riveros

Long

Bachrach

et al. 2020

Journal of Bone and Mineral Research

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Trabecular bone score (TBS) derived from secondary analysis of lumbar spine dual‐energy X‐ray absorptiometry (DXA) scans improves fracture prediction independent of bone mineral density (BMD) in adults. The utility of TBS to assess fracture risk in younger patients has not been established because pediatric norms have been lacking. Robust TBS reference data from the Bone Mineral Density in Childhood Study (BMDCS) have been published. TBS values for the BMDCS study were derived using an algorithm that accounts for tissue thickness (TBSTH) rather than the commercially available algorithm that adjusts for body mass index (BMI; TBSBMI). We examined the magnitude of differences in TBSTH and TBSBMI in a cohort of 189 healthy youth. TBS values using both algorithms increased with age and pubertal development in a similar pattern. However, TBSBMI values were systematically and significantly higher than TBSTH (mean = 0.06, p < 0.0001). The difference between calculated TBSBMI and TBSTH was not uniform. Differences were greater at lower TBS values, in males, in older individuals, in those at later Tanner stages, and in those with a greater BMI Z‐score. These systematic differences preclude the development of a simple formula to allow conversion of TBSBMI to TBSTH “equivalents.” Because of these systematic differences in these two algorithms, using an individual's TBSBMI to calculate a Z‐score using the BMDCS TBSTH reference values results in a falsely higher TBS Z‐score (differences mean = 0.73, interquartile range [IQR] = 0.3 to 1.6). Until TBSTH software for Hologic DXA equipment becomes commercially available, BMDCS TBS reference norms should not be used. © 2023 American Society for Bone and Mineral Research (ASBMR).

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The age‐ and sex‐specific Z ‐scores for both TBS TH and TBS BMI were generated using BMDCS TBS TH norms. ( 16 )…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Trabecular Bone Score (TBS) Varies with Correction for Tissue Thickness Versus Body Mass Index: Implications When Using Pediatric Reference Norms

Riveros

Long

Bachrach

et al. 2020

Journal of Bone and Mineral Research

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Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging

et al. 2023

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Purpose Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. Summary This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice. Supplementary Information ...

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Trabecular Bone Score in Assessing Bone Mineralization Status in Children with End- Stage Renal Disease: A Promising Tool

Salem,

Bakr,

Eid

2023

Eur J Pediatr

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Areal-bone mineral density (aBMD) of lumbar-spine dual energy X-ray absorptiometry (DXA) scan is the most frequently used tool in evaluating BMD in pediatric patients, however its size dependency have significant impact on measurements accuracy in children with chronic kidney disease (CKD). This study aimed to evaluate the usefulness of trabecular bone score (TBS) computed during lumbar-spine DXA scan in assessing bone status in children on maintenance hemodialysis (HD). Ninety-three children on HD (aged 9–18 years) were subjected to lumbar-spine DXA-scan to obtain aBMD (g/cm2) and TBS.Z-scores of aBMD for chronological-age (aBMDZ-CA), height-age (aBMDZ-HA), and TBSZ-score were calculated using mean and SD values of 442 healthy controls. aBMD and TBS were significantly lower in short-for-age and normal height-for-age patients compared to the corresponding values of controls (p < 0.05 for all). Degraded vertebral microarchitecture (TBSZ-score < -2) was detected in 48% and 44% of male and female patients respectively. There were no significant differences in median TBSZ-score between short-for-age and normal height-for-age HD patients in male (p = 0.425) and in female (p = 0.316) patients. TBSZ-score correlated significantly with aBMDZ-CA (r = 0.234; p = 0.024) but not with aBMDZ-HA (r = 0.077; p = 0.462). Patients with history of fractures (5 patients only) had significantly lower TBS scores compared to those without fracture history (p = 0.016).Conclusion: TBS is significantly reduced in children on maintenance HD and is associated with increased fracture incidence. TBS has shown to be a promising tool in assessing bone quality (trabecular microarchitecture) in children with CKD being not size-dependent as is a-BMD, for further evaluation of its potential role in therapeutic and follow-up decisions. What is Known:• In children with CKD, bone demineralization starts as early as CKD stage 2, so assessment of bone health is mandatory for follow up and therapeutic decisions.• aBMD of lumbar-spine DXA scan is the most used tool in evaluating BMD in pediatric patients, however its size dependency have significant impact on measurements made in children with CKD. What is New:• TBS is significantly reduced in children on maintenance HD and associated with increased fracture incidence.• TBS has shown to be a promising tool in assessing bone quality (trabecular microarchitecture) in children with CKD being not size-dependent as is a-BMD.

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Trabecular Bone Score Reference Values for Children and Adolescents According to Age, Sex, and Ancestry

Cited by 15 publications

References 34 publications

Trabecular Bone Score (TBS) Varies with Correction for Tissue Thickness Versus Body Mass Index: Implications When Using Pediatric Reference Norms

Trabecular Bone Score (TBS) Varies with Correction for Tissue Thickness Versus Body Mass Index: Implications When Using Pediatric Reference Norms

Trabecular Bone Score in Assessing Bone Mineralization Status in Children with End- Stage Renal Disease: A Promising Tool

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