A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX.
Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. © 2015 American Society for Bone and Mineral Research.
Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
Eugene V
EV
McCloskey
Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
Anders
A
Odén
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Nicholas C
NC
Harvey
University of Manitoba, Winnipeg, Canada.
William D
WD
Leslie
Lausanne University Hospital, Center of Bone Diseases, Lausanne, Switzerland.
Didier
D
Hans
Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
Helena
H
Johansson
Sektion Biomedizinische Bildgebung Klinik für Diagnostische Radiologie, Kiel, Germany.
Reinhard
R
Barkmann
INSERM UMR 1033 and Lyon University, E Herriot Hospital (HEH), Lyon, France.
Stephanie
S
Boutroy
Department of Rheumatology, Laval University, Québec, Canada.
Jacques
J
Brown
INSERM UMR 1033 and Lyon University, E Herriot Hospital (HEH), Lyon, France.
Roland
R
Chapurlat
Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Petra J M
PJM
Elders
Department of Public Health, Kinki University Faculty of Medicine, Osaka, Japan.
Yuki
Y
Fujita
Sektion Biomedizinische Bildgebung Klinik für Diagnostische Radiologie, Kiel, Germany.
Claus-C
CC
Glüer
Department of Medicine, McGill University Health Centre and McGill University, Montreal, Canada.
David
D
Goltzman
Department of Public Health, Kinki University Faculty of Medicine, Osaka, Japan.
Masayuki
M
Iki
Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Malmö, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
Magnus
M
Karlsson
Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Andreas
A
Kindmark
Epi-Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia.
Mark
M
Kotowicz
Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara, Japan.
Norio
N
Kurumatani
Jockey Club Centre for Osteoporosis Care and Control, the Chinese University of Hong Kong, Hong-Kong, China.
Timothy
T
Kwok
Lausanne University Hospital, Center of Bone Diseases, Lausanne, Switzerland.
Oliver
O
Lamy
Jockey Club Centre for Osteoporosis Care and Control, the Chinese University of Hong Kong, Hong-Kong, China.
Jason
J
Leung
Department of Osteoporosis, Inselspital, Berne University Hospital, Bern, Switzerland.
Kurt
K
Lippuner
Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Östen
Ö
Ljunggren
Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenberg, Sweden.|Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Mattias
M
Lorentzon
Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenberg, Sweden.|Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Dan
D
Mellström
Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Thomas
T
Merlijn
Epi-Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia.
Ling
L
Oei
Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Claes
C
Ohlsson
Epi-Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia.
Julie A
JA
Pasco
Department of Internal Medicine and Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Fernando
F
Rivadeneira
Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Malmö, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
Björn
B
Rosengren
INSERM UMR 1033 and Lyon University, E Herriot Hospital (HEH), Lyon, France.
Elisabeth
E
Sornay-Rendu
INSERM UMR 1033 and Lyon University, E Herriot Hospital (HEH), Lyon, France.
Pawel
P
Szulc
Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan.
Junko
J
Tamaki
Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
John A
JA
Kanis
D015519:Bone Density; D005260:Female; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D008954:Models, Biological; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism; D011446:Prospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism
FRACTURE; FRAX; META-ANALYSIS; RISK; TBS; TRABECULAR BONE STRUCTURE