Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice

Harvey, Nicholas C.; Glüer, Claus‐C.; Binkley, Neil; McCloskey, Eugène; Brandi, Maria Luisa; Cooper, Cyrus; Kendler, David L.; Lamy, Olivier; Laslop, Andrea; Camargos, Bruno Muzzi; Reginster, Jean‐Yves; Rizzoli, René; Kanis, JA

doi:10.1016/j.bone.2015.05.016

Cited by 387 publications

(292 citation statements)

References 78 publications

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“…In fact, fragility fracture risk depends not only on loss of BMD but also on alterations of bone quality [27][28][29] and calcium, 99% of which is included in the skeleton, predominantly affects bone mineralization [2]. A very low daily dietary calcium intake (<400 mg/day) probably leads to a depletion in body calcium content which could compromise good bone mineralization, thus increasing fracture risk.…”

Section: Discussionmentioning

confidence: 99%

Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population

Vannucci

Masi²,

Gronchi

et al. 2017

Arch Osteoporos

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Summary This study was performed in 1000 adult Italian subjects to focus on the effects of dietary calcium intake on bone health. A higher fracture risk appears to be associated with a reduced calcium intake. An adequate daily calcium intake is recommended to counteract osteoporotic fractures. Purpose The principal aim of the present study was to focus on the effects of dietary calcium intake on bone mineral density (BMD) and fragility fractures in a representative sample of an adult Italian outpatient population. Methods The study group consisted of 1000 consecutive adult Italian subjects [838 women (F) and 162 men (M)] referred to the Bone Metabolic Diseases Unit for the evaluation of their bone metabolism. Daily dietary calcium intake was assessed using a specific food frequency questionnaire (FFQ). Other evaluations included fracture risk, lumbar and femoral BMD, heel ultrasound, fragility fractures, plasma concentration of parathyroid hormone ([PTH]) and 25-hydroxy-vitamin D ([25(OH)D]), and urinary calcium. Results Only 10.4% of the subjects (n = 104; 71 F and 33 M) had a daily calcium intake adequate for adults (≥1000 mg/ day). No correlation was found between calcium intake and BMD. The transition from a daily dietary calcium intake <400 mg/day to a daily dietary calcium intake ≥400 mg/day was associated with a reduced fracture probability ratio at any site [from 42 to 21% (p < 0.05)]. Subjects with one or more vertebral fractures had a significantly lower dietary calcium intake (<400 mg/day) than did subjects without vertebral fractures, and they practiced physical activity only occasionally (p = 0.030). Conclusions Daily dietary calcium intake is lower than the recommended daily intake in an Italian ambulatory population, and a higher fracture risk appears to be associated with a reduced calcium intake. An age-adequate daily calcium intake, combined with regular physical activity, is strongly recommended in order to counteract fragility fractures.

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Section: Discussionmentioning

confidence: 99%

Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population

Vannucci

Masi²,

Gronchi

et al. 2017

Arch Osteoporos

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“…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]. TBS increases the ability of the Fracture Risk Assessment Tool (FRAX) to categorize fracture risk, and it has been incorporated into the FRAX model as an adjustment factor [20,23,24].…”

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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“…Unfortunately, HR-pQCT is restricted to peripheral skeletal sites and therefore the lumbar spine or proximal femur (common sites for osteoporotic fragility fractures which are associated with the most significant quality of life burden for patients) cannot be imaged with this technique [15]. TBS, which captures information relating to trabecular microarchitecture by performing novel grey-level texture measurements on DEXA images [16], is undoubtedly promising; however, this tool quantifies the micro architecture of the bone only and does not account for bone chemistry.…”

Section: Introductionmentioning

confidence: 99%

Towards new material biomarkers for fracture risk

Greenwood

Clement

Dicken

et al. 2016

Bone

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Osteoporosis is a prevalent bone condition, characterised by low bone mass and increased fracture risk. Currently, the gold standard for identifying osteoporosis and increased fracture risk is through quantification of bone mineral density (BMD) using dual energy X-ray absorption (DEXA). However, the risk of osteoporotic fracture is determined collectively by bone mass, architecture and physicochemistry of the mineral composite building blocks. Thus DEXA scans alone inevitably fail to fully discriminate individuals who will suffer a fragility fracture. This study examines trabecular bone at both ultrastructure and microarchitectural levels to provide a detailed material view of bone, and therefore provides a more comprehensive explanation of osteoporotic fracture risk. Physicochemical characterisation obtained through X-ray diffraction and infrared analysis indicated significant differences in apatite crystal chemistry and nanostructure between fracture and non-fracture groups.Further, this study, through considering the potential correlations between the chemical biomarkers and microarchitectural properties of trabecular bone, has investigated the relationship between bone mechanical properties (e.g. fragility) and physicochemical material features.

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Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice

Cited by 387 publications

References 78 publications

Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population

Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population

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

Towards new material biomarkers for fracture risk

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