Mirzaei Alireza, Jahed Seyed Adel, Nojomi Marzieh, Rajaei Alireza, Zabihiyeganeh Mozhdeh
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
Diabetes Advisory Committee, Gabric Diabetes Education Association, Tehran, Iran.
Taiwan J Obstet Gynecol. 2018 Jun;57(3):389-393. doi: 10.1016/j.tjog.2018.04.011.
Trabecular Bone Score (TBS) is an index of bone microarchitecture that provides additional skeletal information to areal Bone Mineral Density (aBMD). Recently TBS data has been used to optimize the Fracture Risk Assessment Tool (FRAX) predictive value. The aim of this study was to evaluate the clinical value of TBS on FRAX algorithm.
Among total of 358 postmenopausal Iranian women (mean age 61.3 ± 9.5 years) tested for aBMD and TBS, 184 osteopenic women were identified. Thoracolumbar spine X-ray done in all participants revealed twenty-one vertebral fractures. For the osteopenic group, FRAX and TBS adjusted FRAX (FRAX-TBS) were calculated and compared.
Mean TBS of the patients was 1.31 (±0.11). A significant correlation was found between TBS and spine aBMD (r = 0.50, p < 0.001) and TBS and femoral neck aBMD (r = 0.37, p < 0.0001). A strong positive correlation was observed between aBMD adjusted FRAX and FRAX-TBS in predicting the risk of major osteoporotic fracture (r = 0.90, p < 0.0001), and hip fracture (r = 0.97, p < 0.0001). According to the area under the receiver operating characteristics curve, the predictive value of the three different models using aBMD, TBS, and combination of aBMD and TBS were similar (0.765, 0.776, and 0.781, respectively; p = 0.19). The proportion of the women needed treatment remained unchanged using FRAX or FRAX-TBS.
This study showed no clinical benefit for TBS in postmenopausal women. Adding TBS data to aBMD or FRAX neither improved aBMD predictive value for vertebral fracture nor changed the decision on treatment based on FRAX.
骨小梁评分（TBS）是一种骨微结构指标，可为面积骨密度（aBMD）提供额外的骨骼信息。最近，TBS数据已被用于优化骨折风险评估工具（FRAX）的预测价值。本研究的目的是评估TBS在FRAX算法中的临床价值。
在总共358名接受aBMD和TBS检测的伊朗绝经后女性（平均年龄61.3±9.5岁）中，识别出184名骨质减少的女性。所有参与者均进行了胸腰椎X线检查，发现21例椎体骨折。对于骨质减少组，计算并比较了FRAX和TBS调整后的FRAX（FRAX-TBS）。
患者的平均TBS为1.31（±0.11）。TBS与脊柱aBMD之间存在显著相关性（r = 0.50，p < 0.001），TBS与股骨颈aBMD之间也存在显著相关性（r = 0.37，p < 0.0001）。在预测主要骨质疏松性骨折风险（r = 0.90，p < 0.0001）和髋部骨折风险（r = 0.97，p < 0.0001）方面，aBMD调整后的FRAX与FRAX-TBS之间观察到强正相关。根据受试者工作特征曲线下面积，使用aBMD、TBS以及aBMD和TBS组合的三种不同模型的预测价值相似（分别为0.765、0.776和0.781；p = 0.19）。使用FRAX或FRAX-TBS时，需要治疗的女性比例保持不变。
本研究表明TBS对绝经后女性无临床益处。将TBS数据添加到aBMD或FRAX中，既未提高aBMD对椎体骨折的预测价值，也未改变基于FRAX的治疗决策。
