Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders

Abstract

Trabecular bone score (TBS) index has recently been obtained as a result of textural greyscale analysis of DXA images. Because it enables the assessment of bone microarchitectural texture, TBS may be useful in evaluating bone quality. This study explores the current knowledge of the use of TBS in patients with endocrine disorders with co-occurring bone structure changes. Currently, the clinical importance TBS was verified in terms of disorders of the growth hormone/insulin-like growth factor 1 (GH/IGF-I) axis, glucocorticoid excess, thyroid and parathyroid disease, as well as in diabetes mellitus type 1 and 2. It has been clarified that patients suffering from various endocrinopathies are a group in which TBS should be used routinely because it correlates with clinical factors and may improve patient management in various endocrine disorders. (Endokrynol Pol 2019; 70 (4): 350-356)

Bone status in adolescents and young adults with type 1 diabetes: a 10-year longitudinal study

“…These advantages could favour its use for bone status investigation in paediatrics, but there are some controversies because it does not assess bone structure and geometry separately (parameters influenced by age, height, and timing of sexual maturation). Nonetheless, studies have confirmed the utility of phalangeal QUS in the assessment of bone status in children, adolescents, and young adults, with a very small confounding effect related to bone size, as well as in monitoring longitudinal changes [14][15][16][17].…”

“…The gold standard for diagnosing changes in bone is two-dimensional X-ray absorptiometry (DXA). Although it is a widely used technique and is best for precise assessment, its application for screening purposes in the paediatric population is a point of argument, mainly due to the exposure to X-ray radiation [14,15].…”

Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing’s Syndrome

“…To date, the clinical relevance of TBS analysis was verified in several endocrinopathies associated with increased fracture risk, including disorders of the growth hormone/insulin-like growth factor 1 (GH/IGF-I) axis, diabetes type 1 and 2, primary hyperparathyroidism, and thyroid diseases ( 21 ). There are a few clinical studies documenting associations of autonomous cortisol secretion with TBS in endogenous CS of various etiologies ( 12 , 22 , 23 ).…”

Factors associated with TBS worse than BMD in non-osteoporotic elderly population: Bushehr elderly health program

“…Trabecular bone score (TBS) as a surrogate of bone microstructure and bone quality, can be measured using TBS iNsight software (version 2.2; Medimaps Group, Plan-les-Ouates, Switzerland) which can be applied prospectively or retrospectively to any standard DXA images obtained with the use of modern fan-beam densitometers [ 6 ]. An elevated TBS corresponds to a stronger trabecular structure, while a low TBS is related to a weak fracture-prone bone [ 6 , 7 ].…”

“…TBS can be used as a complement to the BMD in fracture risk assessment [10][11][12] and is partially independent of BMD with different predicting factors. Different conditions including but not limited to glucocorticoid excess, primary hyperparathyroidism, higher free thyroid hormone, diabetes mellitus type 2, androgen-deficiency, chronic kidney disease, autoimmune disorders like rheumatoid arthritis and ankylosing spondylitis, obesity, and smoking are associated with a low TBS and increased fracture risk, independent of BMD [6,[13][14][15][16][17][18][19]. According to a large sample size cohort using Manitoba BMD Registry, the investigators evaluated the effect of TBS after a minimum of 5 years of observation in 37,176 subjects and they found that TBS could predict major osteoporotic fractures and/or hip fracture overall, and several of the considered clinical variables showed significant interactions with TBS.…”