title: Spine bone texture assessed by trabecular bone score (TBS) to evaluate bone health in thalassemia major.
abstract: Due to the increasing survival of thalassemic patients, osteopathy is a mounting clinical problem. Low bone mass alone cannot account for the high fracture risk described; impaired bone quality has been speculated but so far it cannot be demonstrated noninvasively. We studied bone quality in thalassemia major using trabecular bone score (TBS), a novel texture measurement extracted from spine dual-energy X-ray absorptiometry (DXA), proposed in postmenopausal and secondary osteoporosis as an indirect index of microarchitecture. TBS was evaluated in 124 adult thalassemics (age range 19-56 years), followed-up with optimal transfusional and therapeutical regimens, and in 65 non-thalassemic patients (22-52 years) undergoing DXA for different bone diseases. TBS was lower in thalassemic patients (1.04 ± 0.12 [range 0.80-1.30]) versus controls (1.34 ± 0.11 [1.06-1.52]) (p < 0.001), and correlated with BMD. TBS and BMD values correlated with age, indicating that thalassemia negatively affects both bone quality and quantity, especially as the patient gets older. TBS was 1.02 ± 0.11 [0.80-1.28] in the osteoporotic thalassemic patients, 1.08 ± 0.12 [0.82-1.30] in the osteopenic ones and 1.15 ± 0.10 [0.96-1.26] in those with normal BMD. No gender differences were found (males: 1.02 ± 0.13 [0.80-1.30], females 1.05 ± 0.11 [0.80-1.30]), nor between patients with and without endocrine-metabolic disorders affecting bone metabolism. Our findings from a large population with thalassemia major show that TBS is a valuable tool to assess noninvasively bone quality, and it may be related to fragility fracture risk in thalassemic osteopathy.
authors.affiliation: Rare Diseases Center, Department of Medicine and Medical Specialities, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, marina.baldini@policlinico.mi.it.
authors.forename: M
authors.initials: M
authors.lastname: Baldini
authors.forename: F M
authors.initials: FM
authors.lastname: Ulivieri
authors.forename: S
authors.initials: S
authors.lastname: Forti
authors.forename: S
authors.initials: S
authors.lastname: Serafino
authors.forename: S
authors.initials: S
authors.lastname: Seghezzi
authors.forename: A
authors.initials: A
authors.lastname: Marcon
authors.forename: F
authors.initials: F
authors.lastname: Giarda
authors.forename: C
authors.initials: C
authors.lastname: Messina
authors.forename: E
authors.initials: E
authors.lastname: Cassinerio
authors.forename: B
authors.initials: B
authors.lastname: Aubry-Rozier
authors.forename: D
authors.initials: D
authors.lastname: Hans
authors.forename: M D
authors.initials: MD
authors.lastname: Cappellini
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D013131:Spine / Q000000981:diagnostic imaging*; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications*