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Trabecular bone score changes unreliable predictor for fracture in women
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Changes in lumbar spine trabecular bone score may not predict fracture risk among women regardless of osteoporosis treatment initiation, study data show.
William D. Leslie, MD, MSc, of the department of medicine at the University of Manitoba in Canada, and colleagues evaluated data from the Manitoba DXA Registry on 9,044 women (mean age, 62 years) with two consecutive DXA scans not receiving osteoporosis treatment at baseline to determine BMD and trabecular bone score change, osteoporosis treatment and incident major osteoporotic fractures. Follow-up was conducted for a mean of 7.7 years.
Overall, 5,083 participants initiated osteoporosis treatment and 770 participants developed one or more incident major osteoporotic fracture through follow-up.
In untreated participants, fractures were not predicted by change in bone mineral density or trabecular bone score.
A greater antifracture effect for each standard deviation increase in total hip BMD change (fracture decrease, 20%; P < .001), femoral neck BMD change (fracture decrease, 19%; P < .001) and lumbar spine BMD change (fracture decrease, 9%; P = .049) was found among treated women, but changes in trabecular bone score did not predict fractures.
Among treated women, a higher risk for fracture at the total hip (HR = 1.52; 95% CI, 1.21-1.9) and femoral neck (HR = 1.7; 95% CI, 1.27-2.27) were associated with detectable decreases in hip BMD, but a lower risk for fracture was associated with a detectable increase in total hip BMD (HR = 0.8; 95% CI, 0.65-0.99).
“This large, population-based clinical registry demonstrated that untreated women show a decline in BMD and [trabecular bone score] measurements over an average period of 4 years, whereas women highly adherent to antiresorptive treatment (predominantly bisphosphonates) show an increase in these parameters, the magnitude of which varies according to the measurement (greatest for spine BMD and least for spine [trabecular bone score]),” the researchers wrote. “When change was categorized as exceeding the [least significant change], lumbar spine BMD and total hip BMD were the most responsive measurements with approximately one-half of highly adherent women demonstrating a detectable increase.” – by Amber Cox
Disclosure: Leslie reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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