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Low trabecular bone scores tied to increased vertebral fracture risk
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BALTIMORE — Trabecular bone scores showed an independent association with prevalent vertebral fractures and a trend toward prediction of incident vertebral fractures, according to a presenter at ASBMR 2013.
“The trabecular bone score (TBS) is strongly and significantly associated with 1.3 to 1.7 times increased risk for prevalent vertebral fractures per standard deviation (SD) decrease in TBS,” Ling Oei, MD, MSc, MA, an Erasmus MC researcher who is currently a research fellow in the department of genetics at Stanford University, said in her presentation. “Each SD decrease in TBS is also associated with 1.5 times increased risk for clinical incident vertebral fractures, though this is borderline significant in our study.”
said in her presentation. “Each SD decrease in TBS is also associated with 1.5 times increased risk for clinical incident vertebral fractures, though this is borderline significant in our study.”
TBS shows a level of bone quality — as measured by bone texture and microarchitecture — in comparison to bone quantity, as measured by bone mineral density, Oei said.
Three cohorts of the Rotterdam Study were examined in this study, resulting in 2,760 women tested at varying points in the overall study (RS-I during third follow-up, mean age 75.5 years; RS-II during first follow-up, mean age 69.2 years; and RS-III during baseline visit, mean age 58 years). All patients received DXA scans and BMD measurements of the lumbar spine.
The correlation between TBS and lumbar spine BMD was low (Pearson’s correlation coefficient, 0.25-0.3; P<.001), but both measurements were lower in fracture cases than in non-fracture cases (P<.05). In both RS-I and RS-III, lower TBS scores were correlated with increased risk for prevalent vertebral fractures (OR=1.71; 95% CI, 1.29-2.27; and OR=1.27; 95% CI, 1.08-1.48, respectively).
When looking at incident vertebral fractures, RS-I and RS-II data suggested an increased risk per SD decrease in TBS score (HR=1.48; 95% CI, 0.96-2.29).
Adjusted for age, weight and height, both lumbar spine BMD and TBS perform similarly, according to Oei.
“When you combine both, we see that it predicts slightly better,” she said.
For more information:
Oei E. Oral Presentation #1107. Presented at: the American Society for Bone and Mineral Research 2013 Annual Meeting; Oct. 4-7, 2013; Baltimore.
Disclosure: Oei reports no relevant financial disclosures.
Perspective
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Robert D. Blank, MD, PhD
The most important thing is that the relative risk attributable to TBS is independent of BMD, and is detected after adjustment for BMD. However, TBS is not quite as powerful a predictor of fracture risk as BMD is.
We’ve long known that there are many contributors to fracture risk that are not captured by BMD. TBS captures some, but not all of that previously unmeasured risk. One could imagine that just as the FRAX model asks for an input of the BMD or the T-score at the screen, TBS could be included in a similar fashion.
If a facility has TBS capability, it will be incorporated into the DXA report. It will be very simple for frontline clinicians to use it if their reporting facility has it. It’s not something the physician needs to think about, other than recognizing that there might be TBS is appearing as a new feature on their DXA reports.
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