title: Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women.
abstract: Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is used to diagnose osteoporosis and assess fracture risk. However, DXA cannot evaluate trabecular microarchitecture. This study used a novel software program (TBS iNsight; Med-Imaps, Geneva, Switzerland) to estimate bone texture (trabecular bone score [TBS]) from standard spine DXA images. We hypothesized that TBS assessment would differentiate women with low trauma fracture from those without. In this study, TBS was performed blinded to fracture status on existing research DXA lumbar spine (LS) images from 429 women. Mean participant age was 71.3 yr, and 158 had prior fractures. The correlation between LS BMD and TBS was low (r = 0.28), suggesting these parameters reflect different bone properties. Age- and body mass index-adjusted odds ratios (ORs) ranged from 1.36 to 1.63 for LS or hip BMD in discriminating women with low trauma nonvertebral and vertebral fractures. TBS demonstrated ORs from 2.46 to 2.49 for these respective fractures; these remained significant after lowest BMD T-score adjustment (OR = 2.38 and 2.44). Seventy-three percent of all fractures occurred in women without osteoporosis (BMD T-score > -2.5); 72% of these women had a TBS score below the median, thereby appropriately classified them as being at increased risk. In conclusion, TBS assessment enhances DXA by evaluating trabecular pattern and identifying individuals with vertebral or low trauma fracture. TBS identifies 66-70% of women with fracture who were not classified with osteoporosis by BMD alone.
authors.affiliation: Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI, USA. Electronic address: dckruege@wisc.edu.
authors.forename: Diane
authors.initials: D
authors.lastname: Krueger
authors.affiliation: Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Fidler
authors.affiliation: Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI, USA.
authors.forename: Jessie
authors.initials: J
authors.lastname: Libber
authors.affiliation: Department of Bone and Joint, Center of Bone diseases, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Bérengère
authors.initials: B
authors.lastname: Aubry-Rozier
authors.affiliation: Department of Bone and Joint, Center of Bone diseases, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Hans
authors.affiliation: Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Binkley
mesh_terms: D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016103:Spinal Fractures / Q000175:diagnosis*
keywords: Bone mineral density; fracture risk; microarchitecture; trabecular bone score; vertebral fracture