INSERM Unit 1033, Hôpital E. Herriot-Pavillon F, Université de Lyon, 5, place d'Arsonval, 69437, Lyon cedex 03, France.
Osteoporos Int. 2013 Jan;24(1):77-85. doi: 10.1007/s00198-012-2188-2. Epub 2012 Oct 16.
The use of areal bone mineral density (aBMD) for fracture prediction may be enhanced by considering bone microarchitectural deterioration. Trabecular bone score (TBS) helped in redefining a significant subset of non-osteoporotic women as a higher risk group.
TBS is an index of bone microarchitecture. Our goal was to assess the ability of TBS to predict incident fracture.
TBS was assessed in 560 postmenopausal women from the Os des Femmes de Lyon cohort, who had a lumbar spine (LS) DXA scan (QDR 4500A, Hologic) between years 2000 and 2001. During a mean follow-up of 7.8 ± 1.3 years, 94 women sustained 112 fragility fractures.
At the time of baseline DXA scan, women with incident fracture were significantly older (70 ± 9 vs. 65 ± 8 years) and had a lower LS_aBMD and LS_TBS (both -0.4SD, p < 0.001) than women without fracture. The magnitude of fracture prediction was similar for LS_aBMD and LS_TBS (odds ratio [95 % confidence interval] = 1.4 [1.2;1.7] and 1.6 [1.2;2.0]). After adjustment for age and prevalent fracture, LS_TBS remained predictive of an increased risk of fracture. Yet, its addition to age, prevalent fracture, and LS_aBMD did not reach the level of significance to improve the fracture prediction. When using the WHO classification, 39 % of fractures occurred in osteoporotic women, 46 % in osteopenic women, and 15 % in women with T-score > -1. Thirty-seven percent of fractures occurred in the lowest quartile of LS_TBS, regardless of BMD. Moreover, 35 % of fractures that occurred in osteopenic women were classified below this LS_TBS threshold.
In conclusion, LS_aBMD and LS_TBS predicted fractures equally well. In our cohort, the addition of LS_TBS to age and LS_aBMD added only limited information on fracture risk prediction. However, using the lowest quartile of LS_TBS helped in redefining a significant subset of non-osteoporotic women as a higher risk group which is important for patient management.
评估骨小梁分数（TBS）预测骨折的能力。
对里昂女性骨队列中的 560 名绝经后女性进行 TBS 评估，这些女性在 2000 年至 2001 年之间进行了腰椎（LS）双能 X 线吸收法（QDR 4500A，Hologic）扫描。在平均 7.8±1.3 年的随访期间，94 名女性发生了 112 例脆性骨折。
在基线 DXA 扫描时，发生骨折的女性年龄明显较大（70±9 岁 vs. 65±8 岁），LS 骨密度和 LS_TBS 较低（均为-0.4SD，p<0.001）。LS_aBMD 和 LS_TBS 对骨折的预测强度相似（比值比[95%置信区间]分别为 1.4[1.2;1.7]和 1.6[1.2;2.0]）。调整年龄和既往骨折后，LS_TBS 仍然预测骨折风险增加。然而，其与年龄、既往骨折和 LS_aBMD 联合使用并未达到改善骨折预测的显著水平。当使用世界卫生组织（WHO）分类时，39%的骨折发生在骨质疏松症女性中，46%发生在骨量减少症女性中，15%发生在 T 评分>−1 的女性中。37%的骨折发生在 LS_TBS 最低四分位数，无论骨密度如何。此外，35%的骨量减少症女性骨折分类低于 LS_TBS 阈值。
总之，LS_aBMD 和 LS_TBS 同样能很好地预测骨折。在我们的队列中，LS_TBS 与年龄和 LS_aBMD 联合使用仅能提供有限的骨折风险预测信息。然而，使用 LS_TBS 的最低四分位数有助于重新定义一个显著的非骨质疏松女性亚组为更高风险组，这对患者管理很重要。
