Warzecha Maja, Czerwiński Edward, Amarowicz Jarosław, Berwecka Małgorzata
Zakład Chorób Kości i Stawów, Instytut Fizjoterapii, Uniwersytet Jagielloński - Collegium Medicum, Kraków, Polska / Department of Bone and Joint Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow.
Ortop Traumatol Rehabil. 2018 Oct 31;20(5):347-359. doi: 10.5604/01.3001.0012.7281.
Bone mineral density (BMD) assessment is the basic method for assessing fracture risk and diagnosing osteoporosis according to the World Health Organization (WHO). Osteoporosis is diagnosed when the T-score at the proximal femur or spine is T≤-2.5; however, 70% of fractures occur in patients who do not fulfil this criterion. As BMD alone does not adequately predict fracture risk, additional methods supporting risk assessment are needed [3,4]. In 2012, the US Food and Drug Administration (FDA) adopted the Trabecular Bone Score (TBS) as another diagnostic method for osteoporosis. The aim of this study is to evaluate the use of TBS in clinical practice with particular attention to fracture risk assessment, differential diagnosis and assessment of treatment outcomes in patients suffering from primary or secondary osteoporosis. Literature analysis points to the increasing use of TBS in clinical practice. It has been found that, in different subjects with the same BMD, structural bone health is better differentiated using TBS. Additionally, it is valuable to use the DXA along with TBS analysis for improved prediction of fracture risk. Indirect assessment of bone structure with TBS is also helpful in assessing the effect of medications. In conclusion, TBS analysis is a valuable tool in the assessment of bone fracture risk and in the differential diagnosis of structural bone disorders in secondary osteoporosis.
根据世界卫生组织（WHO）的标准，骨密度（BMD）评估是评估骨折风险和诊断骨质疏松症的基本方法。当股骨近端或脊柱的T值≤-2.5时，可诊断为骨质疏松症；然而，70%的骨折发生在不符合该标准的患者中。由于仅骨密度不足以充分预测骨折风险，因此需要其他支持风险评估的方法[3,4]。2012年，美国食品药品监督管理局（FDA）采用小梁骨评分（TBS）作为骨质疏松症的另一种诊断方法。本研究的目的是评估TBS在临床实践中的应用，特别关注原发性或继发性骨质疏松症患者的骨折风险评估、鉴别诊断和治疗效果评估。文献分析表明TBS在临床实践中的应用越来越广泛。研究发现，在骨密度相同的不同受试者中，使用TBS能更好地区分骨骼结构健康状况。此外，将双能X线吸收法（DXA）与TBS分析结合使用，对于提高骨折风险预测也很有价值。用TBS对骨结构进行间接评估，也有助于评估药物疗效。总之，TBS分析是评估骨折风险和鉴别继发性骨质疏松症中骨骼结构紊乱的有价值工具。
