[炎症性风湿性疾病和非炎症性疾病患者常规临床护理中骨小梁评分（TBS）的评估：与传统骨密度测量的相关性及椎体骨折患病率]

[Evaluation of the trabecular bone score (TBS) in routine clinical care of patients with inflammatory rheumatic and non-inflammatory diseases : Correlation with conventional bone mineral density measurement and prevalence of vertebral fractures].

作者信息

Buehring B, Thomas J, Wittkämper T, Baraliakos X, Braun J

机构信息

Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.

Radiologie Herne, Herne, Deutschland.

出版信息

Z Rheumatol. 2020 Dec;79(10):1067-1074. doi: 10.1007/s00393-020-00764-9.

DOI:10.1007/s00393-020-00764-9

PMID:32162022

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7708337/

Abstract

BACKGROUND

Osteoporosis-related fractures are common in patients with rheumatoid arthritis (RA). Bone mineral density (BMD) measurements using dual-energy x‑ray absorptiometry (DXA) alone has only a limited value for predicting the risk of fractures. The trabecular bone score (TBS) is a surrogate parameter for trabecular microarchitecture of bone and a predictor of fracture risk independent of BMD.

AIM

To examine the prevalence of BMD, TBS and osteoporosis-related vertebral fractures (VF) in patients with RA in comparison to controls with non-inflammatory musculoskeletal diseases.

METHODS

Data from patients with RA diagnosed by a rheumatologist and with TBS and DXA measurements, who were assessed in this hospital between 2006 and 2014 were retrospectively analyzed. The RA patients were matched with controls with non-inflammatory musculoskeletal diseases. "Reduced bone health" was defined as a T‑score <-1.0 and/or a TBS value <-1.31. Statistical analyses were carried out using the Mann-Whitney test and the Wilcoxon test.

RESULTS

Data from 143 patients with RA (age 72.1 ± 11.1 years, 72% female) and 106 controls (age 69.6 ± 12.6 years, 75% female) were included. The RA patients more frequently had low BMD (n = 102, 71.3%) and low TBS values (n = 125, 87.4%) compared to controls (n = 63, 59.4% and n = 79, 74.5%, p = 0.049 and p = 0.009, respectively). The RA patients had more VF (n = 52, 36.4%) than controls (n = 24, 22.6%, p = 0.02). A total of 20 patients with VF (26.3%) had normal lumbar spine BMD and 9 (11.8%) also had a normal hip BMD. In patients with VF the combination of low TBS with normal spine BMD was more common than a normal TBS and low spine BMD (p = 0.008 for patients with RA, p = 0.025 for controls).

DISCUSSION

It is known that VF can occur in patients with normal BMD. In patients with VF, a low TBS with normal spine BMD is found more frequently than normal TBS and low spine BMD. These results suggest that measurement of the TBS has the potential to be a useful tool to detect increased fracture risk in patients with RA and normal spine BMD.

摘要

背景

骨质疏松相关骨折在类风湿关节炎（RA）患者中很常见。单独使用双能X线吸收法（DXA）测量骨密度（BMD）对预测骨折风险的价值有限。小梁骨评分（TBS）是骨小梁微结构的替代参数，也是独立于BMD的骨折风险预测指标。

目的

与非炎性肌肉骨骼疾病对照组相比，研究RA患者中BMD、TBS及骨质疏松相关椎体骨折（VF）的患病率。

方法

回顾性分析2006年至2014年在本院评估的、由风湿病学家诊断为RA且进行了TBS和DXA测量的患者数据。将RA患者与非炎性肌肉骨骼疾病对照组进行匹配。“骨健康降低”定义为T值＜-1.0和/或TBS值＜-1.31。采用Mann-Whitney检验和Wilcoxon检验进行统计分析。

结果

纳入143例RA患者（年龄72.1±11.1岁，72%为女性）和106例对照组（年龄69.6±12.6岁，75%为女性）。与对照组相比，RA患者BMD低（n = 102，71.3%）和TBS值低（n = 125，87.4%）更为常见（对照组分别为n = 63，59.4%和n = 79，74.5%，p分别为0.049和0.009）。RA患者的VF多于对照组（n = 52，36.4%比n = 24，22.6%，p = 0.02）。共有20例VF患者（26.3%）腰椎BMD正常，9例（11.8%）髋部BMD也正常。在VF患者中，TBS低合并脊柱BMD正常比TBS正常合并脊柱BMD低更常见（RA患者中p = 0.008，对照组中p = 0.025）。