Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea.
J Bone Miner Metab. 2019 May;37(3):475-483. doi: 10.1007/s00774-018-0938-8. Epub 2018 Jun 28.
The trabecular bone score (TBS) is a textural index that indirectly assesses bone trabecular microarchitecture using lumbar spine images obtained by dual-energy X-ray absorptiometry (DXA). This study compared the TBS of patients with end-stage kidney disease (ESKD) with that of matched controls to identify risk factors associated with a low TBS. TBS and bone mineral density (BMD) were assessed in ESKD patients (n = 76) and age- and sex-matched control subjects (n = 76) using DXA. The TBS of both groups was then compared, and risk factors associated with a low TBS (defined as ≤ 1.31) were evaluated. The mean TBS in the ESKD group was significantly lower than that in the control group (1.34 ± 0.15 vs. 1.43 ± 0.08, respectively; p < 0.001). More subjects in the ESKD group had a low TBS [34.2% (ESRD) vs. 5.3% (controls); p < 0.001]. The TBS was negatively correlated with age, alkaline phosphatase and C-reactive protein levels, and dialysis vintage, and positively correlated with BMD at the lumbar spine, femoral neck, and hip. Multivariate analysis identified lower estimated glomerular filtration rate and increased C-reactive protein levels as being significantly associated with a low TBS. In conclusion, ESKD patients had abnormal bone microarchitecture (as assessed by the TBS). The TBS was positively correlated with BMD. Renal function and inflammatory marker levels were independently associated with a low TBS. Thus, TBS may be a useful clinical tool for assessing cancellous bone connectivity in ESKD patients.
骨小梁评分（TBS）是一种纹理指数，它使用双能 X 射线吸收法（DXA）获得的腰椎图像间接评估骨小梁微结构。本研究比较了终末期肾病（ESKD）患者和匹配对照者的 TBS，以确定与 TBS 降低相关的危险因素。使用 DXA 评估 ESKD 患者（n=76）和年龄及性别匹配的对照者（n=76）的 TBS 和骨密度（BMD）。然后比较两组的 TBS，并评估与 TBS 降低（定义为≤1.31）相关的危险因素。ESKD 组的平均 TBS 明显低于对照组（分别为 1.34±0.15 和 1.43±0.08，p<0.001）。ESKD 组中 TBS 降低的患者更多[34.2%（ESRD）比 5.3%（对照组）；p<0.001]。TBS 与年龄、碱性磷酸酶和 C 反应蛋白水平以及透析龄呈负相关，与腰椎、股骨颈和髋部的 BMD 呈正相关。多变量分析发现，估算肾小球滤过率降低和 C 反应蛋白水平升高与 TBS 降低显著相关。总之，ESKD 患者的骨小梁微结构异常（通过 TBS 评估）。TBS 与 BMD 呈正相关。肾功能和炎症标志物水平与 TBS 降低独立相关。因此，TBS 可能是评估 ESKD 患者松质骨连通性的有用临床工具。
