Touvier J, Winzenrieth R, Johansson H, Roux J P, Chaintreuil J, Toumi H, Jennane R, Hans D, Lespessailles E
I3MTO, EA4708, Université d'Orléans, 1, Rue Porte-Madeleine, Orléans, BP 2439, 45032 Cedex 1, France,
Calcif Tissue Int. 2015 Apr;96(4):274-83. doi: 10.1007/s00223-015-9952-1. Epub 2015 Jan 14.
The use of bone mineral density (BMD) for fracture discrimination may be improved by considering bone microarchitecture. Texture parameters such as trabecular bone score (TBS) or mean Hurst parameter (H) could help to find women who are at high risk of fracture in the non-osteoporotic group. The purpose of this study was to combine BMD and microarchitectural texture parameters (spine TBS and calcaneus H) for the detection of osteoporotic fractures. Two hundred and fifty five women had a lumbar spine (LS), total hip (TH), and femoral neck (FN) DXA. Additionally, texture analyses were performed with TBS on spine DXA and with H on calcaneus radiographs. Seventy-nine women had prevalent fragility fractures. The association with fracture was evaluated by multivariate logistic regressions. The diagnostic value of each parameter alone and together was evaluated by odds ratios (OR). The area under curve (AUC) of the receiver operating characteristics (ROC) were assessed in models including BMD, H, and TBS. Women were also classified above and under the lowest tertile of H or TBS according to their BMD status. Women with prevalent fracture were older and had lower TBS, H, LS-BMD, and TH-BMD than women without fracture. Age-adjusted ORs were 1.66, 1.70, and 1.93 for LS, FN, and TH-BMD, respectively. Both TBS and H remained significantly associated with fracture after adjustment for age and TH-BMD: OR 2.07 [1.43; 3.05] and 1.47 [1.04; 2.11], respectively. The addition of texture parameters in the multivariate models didn't show a significant improvement of the ROC-AUC. However, women with normal or osteopenic BMD in the lowest range of TBS or H had significantly more fractures than women above the TBS or the H threshold. We have shown the potential interest of texture parameters such as TBS and H in addition to BMD to discriminate patients with or without osteoporotic fractures. However, their clinical added values should be evaluated relative to other risk factors.
通过考虑骨微结构，骨密度（BMD）用于骨折鉴别的效能可能会得到提高。诸如小梁骨评分（TBS）或平均赫斯特参数（H）等纹理参数有助于找出非骨质疏松组中骨折高危女性。本研究的目的是将BMD与微结构纹理参数（脊柱TBS和跟骨H）相结合，以检测骨质疏松性骨折。255名女性接受了腰椎（LS）、全髋（TH）和股骨颈（FN）的双能X线吸收法（DXA）检查。此外，对脊柱DXA进行TBS纹理分析，对跟骨X线片进行H分析。79名女性有既往脆性骨折史。通过多因素逻辑回归评估与骨折的相关性。通过比值比（OR）评估每个参数单独及联合的诊断价值。在包含BMD、H和TBS的模型中评估受试者工作特征（ROC）曲线下面积（AUC）。女性也根据其BMD状态分为H或TBS最低三分位数以上和以下。有既往骨折的女性比无骨折的女性年龄更大，TBS、H、LS-BMD和TH-BMD更低。年龄调整后的OR值，LS、FN和TH-BMD分别为1.66、1.70和1.93。在调整年龄和TH-BMD后，TBS和H与骨折仍显著相关：OR分别为2.07 [1.43；3.05]和1.47 [1.04；2.11]。在多因素模型中加入纹理参数并未显示ROC-AUC有显著改善。然而，TBS或H处于最低范围的骨量正常或骨量减少的女性比TBS或H阈值以上的女性骨折明显更多。我们已经证明，除BMD外，TBS和H等纹理参数在鉴别有无骨质疏松性骨折患者方面具有潜在价值。然而，它们的临床附加值应相对于其他危险因素进行评估。
