The Mellanby Centre for Bone Research, Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK.
Department of Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Osteoporos Int. 2020 Apr;31(4):667-675. doi: 10.1007/s00198-020-05317-z. Epub 2020 Jan 28.
Lumbar spine volumetric bone mineral density (BMD) measured using quantitative computed tomography (QCT) can discriminate between postmenopausal women with low areal BMD with and without vertebral fractures. QCT provides a 3D measure of BMD, excludes the vertebral posterior elements and accounts for bone size. This knowledge could contribute to effective treatment targeting of patients with low BMD.
We evaluated the ability of lumbar spine bone mineral apparent density (BMAD), trabecular bone score (TBS) and volumetric bone mineral density (vBMD) to discriminate between postmenopausal women with low areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) with and without vertebral fractures. The discriminatory ability of lumbar spine aBMD was compared with that of BMAD, TBS and vBMD.
We studied three groups of postmenopausal women, i.e. group 1, aBMD T-score < - 1.0 and ≥ 1 vertebral fracture (n = 39); group 2, aBMD T-score < - 1.0 and no vertebral fracture, age- and aBMD-matched to group 1 (n = 34); group 3, aBMD score > - 1 and no vertebral fracture, age-matched to group 1 (n = 37). Lumbar spine aBMD was measured by DXA. BMAD was calculated using the DXA scan results. TBS was derived following DXA scan image reanalysis. Lumbar spine vBMD was assessed by quantitative computed tomography and Mindways Pro software. Differences in variables between groups 1, 2 and 3 were examined using general linear univariate modelling approaches. Area under the receiver operating characteristic (ROC) curve was calculated for BMAD, TBS and vBMD to determine the ability of lumbar spine measurement variables to discriminate between group 1 and group 2. A comparison of ROCs was performed.
Lumbar spine BMAD and TBS measurement variables were similar for groups 1 and 2. However, vBMD was significantly lower in group 1 and could discriminate between those women with low aBMD with (group 1) and without vertebral fractures (group 2).
We conclude that lumbar spine vBMD may discriminate well between postmenopausal women with low aBMD with and without vertebral fractures as it provides a 3D measure of bone mineral density, excludes the posterior elements of the vertebrae and takes into account bone size. A unique feature of the SHATTER study is that groups 1 and 2 were matched for aBMD, thus our study findings are independent of aBMD. Furthermore, we observed that neither BMAD nor TBS could distinguish between women with low aBMD with and without vertebral fractures. The knowledge gained from the SHATTER study will influence clinical and therapeutic decision-making, thereby optimising the care of patients with and without vertebral and other fragility fractures.
使用定量计算机断层扫描（QCT）测量腰椎容积骨矿物质密度（BMD）可区分绝经后低骨密度（BMD）伴和不伴椎体骨折的女性。QCT 提供了 BMD 的 3D 测量值，排除了椎体的后元素并考虑了骨的大小。这些知识可能有助于针对低 BMD 患者进行有效的治疗。
我们评估了腰椎骨矿物质表观密度（BMAD）、骨小梁评分（TBS）和容积骨矿物质密度（vBMD）在通过双能 X 射线吸收法（DXA）测量伴和不伴椎体骨折的绝经后低骨密度（aBMD）女性中区分的能力。腰椎 aBMD 的区分能力与 BMAD、TBS 和 vBMD 进行了比较。
我们研究了三组绝经后妇女，即第 1 组，aBMD T 评分＜-1.0 和≥1 个椎体骨折（n=39）；第 2 组，aBMD T 评分＜-1.0 且无椎体骨折，年龄和 aBMD 与第 1 组匹配（n=34）；第 3 组，aBMD 评分＞-1 且无椎体骨折，年龄与第 1 组匹配（n=37）。腰椎 aBMD 通过 DXA 测量。使用 DXA 扫描结果计算 BMAD。TBS 是在 DXA 扫描图像重新分析后得出的。使用定量计算机断层扫描和 Mindways Pro 软件评估腰椎 vBMD。使用一般线性单变量建模方法检查组 1、2 和 3 之间变量的差异。计算 BMAD、TBS 和 vBMD 的接收者操作特征（ROC）曲线下面积，以确定腰椎测量变量区分组 1 和组 2 的能力。进行 ROC 比较。
第 1 组和第 2 组的腰椎 BMAD 和 TBS 测量变量相似。然而，第 1 组的 vBMD 明显较低，可区分低 aBMD 伴（第 1 组）和不伴椎体骨折（第 2 组）的女性。
我们得出结论，腰椎 vBMD 可能很好地区分绝经后低 aBMD 伴和不伴椎体骨折的女性，因为它提供了 BMD 的 3D 测量值，排除了椎体的后元素，并考虑了骨的大小。SHATTER 研究的一个独特特点是组 1 和 2 为 aBMD 匹配，因此我们的研究结果独立于 aBMD。此外，我们观察到 BMAD 和 TBS 均不能区分低 aBMD 伴和不伴椎体骨折的女性。SHATTER 研究的结果将影响临床和治疗决策，从而优化有和无椎体和其他脆性骨折患者的护理。
