Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA.
Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA.
J Clin Densitom. 2018 Apr-Jun;21(2):185-192. doi: 10.1016/j.jocd.2017.09.003. Epub 2017 Nov 1.
Trabecular bone score (TBS) is a texture parameter that measures the grayscale variation within dual-energy X-ray absorptiometry (DXA) images, and has been shown to significantly correlate with the 3-dimensional bone microarchitecture. The objective of this study was to determine whether TBS is a better clinical tool than traditionally used bone mineral density (BMD) to detect the skeletal deterioration seen in patients with diabetes (DM), patients undergoing oral glucocorticoid (GC) therapy, and patients who are both diabetic and taking steroids (GC + DM). We performed retrospective, cross-sectional study using DXA images of patients who visited UTHealth Department of Internal Medicine DXA clinic in Houston, TX, from May 30, 2014 to May 30, 2016. A total of 477 men and women, who were 55 years or older, were included in the study. Lumbar spine (LS) BMD and TBS were collected. Electronic medical records were reviewed to collect clinical information for each patient. When both men and women were analyzed as a single group, LS-BMD was significantly higher in the diabetic group than in the control group (1.14 vs 1.10, p = 0.038), whereas mean TBS of L1-L4 was significantly lower in the diabetic group (1.21 vs 1.26, p = 0.004). LS-TBS was also significantly lower in diabetic women than in nondiabetic women (1.20 vs 1.26, p = 0.002). Receiver operating characteristic curves and areas under the curve indicated that LS-TBS provided better ability than LS-BMD to discriminate between control subjects and those in the DM, GC, or GC + DM groups (areas under the curve between 0.645 and 0.697, p < 0.010 for all). LS-TBS is a BMD-independent parameter that is capable of capturing a larger portion of bone quality deterioration undetected by BMD alone in patients with DM and undergoing oral GC therapy.
骨小梁评分（TBS）是一种纹理参数，用于测量双能 X 射线吸收法（DXA）图像中的灰度变化，并且与三维骨微结构具有显著相关性。本研究的目的是确定 TBS 是否比传统使用的骨密度（BMD）更能作为一种临床工具，用于检测糖尿病（DM）患者、接受口服糖皮质激素（GC）治疗的患者以及同时患有糖尿病和服用类固醇（GC+DM）的患者的骨骼恶化。我们使用 2014 年 5 月 30 日至 2016 年 5 月 30 日期间在德克萨斯州休斯顿 UTHealth 内科 DXA 诊所就诊的患者的 DXA 图像进行了回顾性、横断面研究。共纳入 477 名年龄在 55 岁及以上的男性和女性。收集了腰椎（LS）BMD 和 TBS。查阅电子病历，收集每位患者的临床信息。当将男性和女性作为一个整体进行分析时，糖尿病组的 LS-BMD 明显高于对照组（1.14 对 1.10，p=0.038），而糖尿病组 L1-L4 的平均 TBS 明显较低（1.21 对 1.26，p=0.004）。糖尿病女性的 LS-TBS 也明显低于非糖尿病女性（1.20 对 1.26，p=0.002）。受试者工作特征曲线和曲线下面积表明，LS-TBS 比 LS-BMD 更能区分对照组与 DM、GC 或 GC+DM 组（曲线下面积在 0.645 到 0.697 之间，所有 p<0.010）。LS-TBS 是一种与 BMD 无关的参数，能够在接受口服 GC 治疗的 DM 患者中捕捉到 BMD 单独检测不到的更大部分的骨质量恶化。
