Leslie William D, Majumdar Sumit R, Morin Suzanne N, Hans Didier, Lix Lisa M
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Department of Medicine, University of Alberta, Edmonton, Canada.
J Bone Miner Res. 2017 Mar;32(3):618-623. doi: 10.1002/jbmr.3054. Epub 2016 Dec 29.
Bone mineral density (BMD) and trabecular bone score (TBS), along with additional clinical risk factors, can be used to identify individuals at high fracture risk. Whether change in TBS in untreated or treated women independently affects fracture risk is unclear. Using the Manitoba (Canada) DXA Registry containing all BMD results for the population we identified 9044 women age ≥40 years with two consecutive DXA scans and who were not receiving osteoporosis treatment at baseline (baseline mean age 62 ± 10 years). We examined BMD and TBS change, osteoporosis treatment, and incident major osteoporotic fractures (MOFs) for each individual. Over a mean of 7.7 years follow-up, 770 women developed an incident MOF. During the interval between the two DXA scans (mean, 4.1 years), 5083 women initiated osteoporosis treatment (bisphosphonate use 80%) whereas 3961 women did not receive any osteoporosis treatment. Larger gains in both BMD and TBS were seen in women with greater adherence to osteoporosis medication (p for trend <0.001), and the magnitude of the increase was consistently greater for BMD than for TBS. Among treated women there was greater antifracture effect for each SD increase in total hip BMD change (fracture decrease 20%; 95% CI, 13% to 26%; p < 0.001), femoral neck BMD change (19%; 95% CI, 12% to 26%; p < 0.001), and lumbar spine BMD change (9%; 95% CI, 0% to 17%; p = 0.049). In contrast, change in TBS did not predict fractures in women who initiated osteoporosis treatment (p = 0.10). Among untreated women neither change in BMD or TBS predicted fractures. We conclude that, unlike antiresorptive treatment-related changes in BMD, change in lumbar spine TBS is not a useful indicator of fracture risk irrespective of osteoporosis treatment. © 2016 American Society for Bone and Mineral Research.
骨密度（BMD）和小梁骨评分（TBS），连同其他临床风险因素，可用于识别骨折风险高的个体。未经治疗或已治疗女性的TBS变化是否独立影响骨折风险尚不清楚。利用加拿大曼尼托巴省双能X线吸收测定法（DXA）登记处中该人群的所有BMD结果，我们识别出9044名年龄≥40岁、有两次连续DXA扫描且基线时未接受骨质疏松症治疗的女性（基线平均年龄62±10岁）。我们检查了每个人的BMD和TBS变化、骨质疏松症治疗情况以及新发的严重骨质疏松性骨折（MOF）。在平均7.7年的随访期间，770名女性发生了新发MOF。在两次DXA扫描间隔期间（平均4.1年），5083名女性开始接受骨质疏松症治疗（80%使用双膦酸盐），而3961名女性未接受任何骨质疏松症治疗。在更坚持使用骨质疏松症药物的女性中，BMD和TBS的增加幅度更大（趋势p<0.001），且BMD的增加幅度始终大于TBS。在接受治疗的女性中，全髋BMD变化每增加1个标准差，抗骨折效果更强（骨折风险降低20%；95%置信区间，13%至26%；p<0.001），股骨颈BMD变化（19%；95%置信区间，12%至26%；p<0.001），以及腰椎BMD变化（9%；95%置信区间，0%至17%；p=0.049）。相比之下，TBS变化并不能预测开始接受骨质疏松症治疗女性的骨折情况（p=0.10）。在未接受治疗的女性中，BMD或TBS的变化均不能预测骨折。我们得出结论，与抗吸收治疗相关的BMD变化不同，无论是否进行骨质疏松症治疗，腰椎TBS变化都不是骨折风险的有用指标。©2016美国骨与矿物质研究学会。
