Ripamonti Claudio, Lisi Lucia, Buffa Angela, Gnudi Saverio, Caudarella Renata
Struttura Semplice Osteoporosi e Malattie Metaboliche dello Scheleletro, Bologna, Italy.
Struttura Semplice Dipartimentale Medicina e Reumatologia Istituto Ortopedico Rizzoli, Bologna, Italy.
Med Arch. 2018 Feb;72(1):46-50. doi: 10.5455/medarh.2018.72.46-50.
The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture. Several literature data suggest that TBS predicts fracture risk as well as lumbar spine bone mineral density (LS-BMD) measurements in postmenopausal women.
A retrospective case-control study assessing the ability of the TBS to predict spine fragility fractures (SFF) in postmenopausal women with or without osteoporosis (diagnosed by T-score≤-2.5).
LS-BMD and the TBS were determined in the L1-L4 vertebrae. Statistical analyses were carried out in the entire group of women (entire-group) (n.699), in women both with osteoporosis (osteoporosis-subgroup) (n.253) and those without osteoporosis (non-osteoporosis-subgroup) (n. 446).
At the unpaired t-test, both the TBS and the LS-BMD (p≤0.001) were lower in women with SFF (n.62) in the entire-group. In the non-osteoporosis subgroup, the TBS (p≤0.009) was lower in women with SFF (n.29). In the osteoporosis subgroup, the LS-BMD (p≤0.003) was lower in women with SFF (n.33). Considering the TBS and LS-BMD separately in a block logistic regression, the TBS was associated with SFF in the entire-group (odds ratio (OR): 1.599, 95% confidence interval (CI): 1.021-2.128) and in the non-osteoporosis-subgroup (OR: 1.725, 95% CI:1.118-2.660) whereas LS-BMD was associated with SFF in the entire-group (OR: 1.611, 95% CI: 1.187-2.187) and in the osteoporosis-subgroup (OR: 2.383, 95% CI: 1.135-5.003). According to forward logistic regression, entering the TBS, LS-BMD and confounders as predictors, the LS-BMD in the entire-group (OR: 1.620, 95% CI: 1.229-2.135) and in the osteoporosis subgroup (OR: 2.344, 95% CI: 1.194-4.600), and the TBS in the non-osteoporosis subgroup (OR: 1.685, 95% CI: 1.131-2.511) were the only predictors of SFFs.
In the entire-group, the TBS predicted SFFs almost as well as LS-BMD, but not independently of it. The TBS, but not LS-BMD, predicted SFFs in the non-osteoporosis subgroup.
小梁骨评分（TBS）是一种灰度纹理指标，可从二维腰椎双能X线吸收法（DXA）图像中提取。TBS与骨微结构相关。多项文献数据表明，TBS在预测绝经后女性骨折风险方面与腰椎骨密度（LS - BMD）测量结果相当。
一项回顾性病例对照研究，评估TBS预测有或无骨质疏松症（通过T值≤ - 2.5诊断）的绝经后女性脊柱脆性骨折（SFF）的能力。
测定L1 - L4椎体的LS - BMD和TBS。在所有女性组成的整个组（n = 699）、患有骨质疏松症的女性（骨质疏松症亚组）（n = 253）和未患骨质疏松症的女性（非骨质疏松症亚组）（n = 446）中进行统计分析。
在非配对t检验中，整个组中发生SFF的女性（n = 62）的TBS和LS - BMD均较低（p≤0.001）。在非骨质疏松症亚组中，发生SFF的女性（n = 29）的TBS较低（p≤0.009）。在骨质疏松症亚组中，发生SFF的女性（n = 33）的LS - BMD较低（p≤0.003）。在二元逻辑回归中分别考虑TBS和LS - BMD，TBS在整个组（优势比（OR）：1.599，95%置信区间（CI）：1.021 - 2.128）和非骨质疏松症亚组（OR：1.725，95% CI：1.118 - 2.660）中与SFF相关，而LS - BMD在整个组（OR：1.611，95% CI：1.187 - 2.187）和骨质疏松症亚组（OR：2.383，95% CI：1.135 - 5.003）中与SFF相关。根据向前逻辑回归，将TBS、LS - BMD和混杂因素作为预测因子纳入，整个组（OR：1.620，95% CI：1.229 - 2.135）和骨质疏松症亚组（OR：2.344，95% CI：1.194 - 4.600）中的LS - BMD以及非骨质疏松症亚组中的TBS（OR：1.685，95% CI：1.131 - 2.511）是SFF的唯一预测因子。
在整个组中，TBS预测SFF的能力与LS - BMD相近，但并非独立于LS - BMD。在非骨质疏松症亚组中，是TBS而非LS - BMD能够预测SFF。
