title: Trabecular bone score (TBS)--a novel method to evaluate bone microarchitectural texture in patients with primary hyperparathyroidism.
abstract: BACKGROUND
  In the milder form of primary hyperparathyroidism (PHPT), cancellous bone, represented by areal bone mineral density at the lumbar spine by dual-energy x-ray absorptiometry (DXA), is preserved. This finding is in contrast to high-resolution peripheral quantitative computed tomography (HRpQCT) results of abnormal trabecular microstructure and epidemiological evidence for increased overall fracture risk in PHPT. Because DXA does not directly measure trabecular bone and HRpQCT is not widely available, we used trabecular bone score (TBS), a novel gray-level textural analysis applied to spine DXA images, to estimate indirectly trabecular microarchitecture.
  
  
  OBJECTIVE
  The purpose of this study was to assess TBS from spine DXA images in relation to HRpQCT indices and bone stiffness in radius and tibia in PHPT.
  
  
  METHODS
  This was a cross-sectional study conducted in a referral center.
  
  
  METHODS
  Participants were 22 postmenopausal women with PHPT.
  
  
  METHODS
  Outcomes measured were areal bone mineral density by DXA, TBS indices derived from DXA images, HRpQCT standard measures, and bone stiffness assessed by finite element analysis at distal radius and tibia.
  
  
  RESULTS
  TBS in PHPT was low at 1.24, representing abnormal trabecular microstructure (normal ≥1.35). TBS was correlated with whole bone stiffness and all HRpQCT indices, except for trabecular thickness and trabecular stiffness at the radius. At the tibia, correlations were observed between TBS and volumetric densities, cortical thickness, trabecular bone volume, and whole bone stiffness. TBS correlated with all indices of trabecular microarchitecture, except trabecular thickness, after adjustment for body weight.
  
  
  CONCLUSIONS
  TBS, a measurement technology readily available by DXA, shows promise in the clinical assessment of trabecular microstructure in PHPT.
authors.affiliation: Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. bcs2131@columbia.edu
authors.forename: Barbara Campolina
authors.initials: BC
authors.lastname: Silva
authors.forename: Stephanie
authors.initials: S
authors.lastname: Boutroy
authors.forename: Chiyuan
authors.initials: C
authors.lastname: Zhang
authors.forename: Donald Jay
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
authors.forename: Ji
authors.initials: J
authors.lastname: Wang
authors.forename: Julia
authors.initials: J
authors.lastname: Udesky
authors.forename: Serge
authors.initials: S
authors.lastname: Cremers
authors.forename: Marta
authors.initials: M
authors.lastname: Sarquis
authors.forename: Xiang-Dong Edward
authors.initials: XD
authors.lastname: Guo
authors.forename: Didier
authors.initials: D
authors.lastname: Hans
authors.forename: John Paul
authors.initials: JP
authors.lastname: Bilezikian
mesh_terms: D015502:Absorptiometry, Photon; D000046:Academic Medical Centers; D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000209:etiology*; D001842:Bone and Bones / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology*; D055598:Chemical Phenomena; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D021621:Imaging, Three-Dimensional; D009519:New York City / Q000453:epidemiology; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012306:Risk; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed