Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.
Department for Pediatric Neurology, Social Pediatrics and Epileptology, Justus-Liebig University Giessen and University Hospital of Giessen and Marburg (UKGM), Giessen, Germany.
J Bone Miner Res. 2020 Sep;35(9):1685-1694. doi: 10.1002/jbmr.4047. Epub 2020 Jun 1.
Bone strength and fracture risk do not only depend on bone density, but also on bone structure. The trabecular bone score (TBS) evaluates homogeneity of bone microarchitecture indirectly by measuring gray-level variations of two-dimensional (2D) DXA images. Although TBS is well-established for adults, there have been only few publications in pediatrics. In this monocentric retrospective analysis, we investigated TBS in children and adolescents with cerebral palsy (CP), a patient group vulnerable to low bone mineral mass due to impaired mobility. The influence of different parameters on TBS and areal BMD (aBMD) were evaluated, as well as the relationship between TBS and aBMD. We compared TBS values of our study population to a reference population. A total of 472 lumbar spine-dual-energy X-ray absorptiometry (LS-DXA) scans of children and adolescents with CP (205 female), aged between 4 and 18 years, were analyzed. The DXA-scans were part of the routine examination. The children had no records of fractures or specific bone diseases. Our study population with CP had similar TBS as the reference population. TBS did not increase with age until an inflection point at 10 years in females, and 12 years in males. Girls had significantly higher TBS than boys (p = .049) and pubertal girls aged 8 to 13 years had significantly higher TBS than prepubertal girls (p = .009). TBS standard deviation score for age (SDS-TBS) and aBMD Z-scores correlated weakly (p < .001; R = 0.276 [males], R = 0.284 [females]). Other than for aBMD Z-scores, SDS-TBS was not influenced by age-adjusted height Z-scores and there was no significant difference in SDS-TBS when grouped by mobility levels, using the Gross Motor Function Classification System (GMFCS). Our results indicate that children with CP have a similar homogeneous distribution of trabecular microarchitecture as controls. Puberty initiation appears to be essential for increase of TBS with age and for sex differences. TBS seems less influenced by body composition, height, and mobility than aBMD. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
骨强度和骨折风险不仅取决于骨密度，还取决于骨结构。骨小梁评分（TBS）通过测量二维（2D）双能 X 射线吸收法（DXA）图像的灰度变化间接评估骨微结构的均匀性。尽管 TBS 在成年人中已经得到很好的建立，但在儿科领域只有很少的出版物。在这项单中心回顾性分析中，我们研究了脑瘫（CP）患儿和青少年的 TBS，CP 患者由于活动能力受损，骨矿物质质量较低，属于易患人群。评估了不同参数对 TBS 和面积骨密度（aBMD）的影响，以及 TBS 和 aBMD 之间的关系。我们将研究人群的 TBS 值与参考人群进行了比较。共分析了 472 例脑瘫患儿和青少年（205 例女性）的腰椎双能 X 射线吸收法（LS-DXA）扫描，年龄在 4 至 18 岁之间。DXA 扫描是常规检查的一部分。这些儿童没有骨折或特定骨骼疾病的记录。我们的 CP 研究人群的 TBS 与参考人群相似。TBS 直到女性 10 岁和男性 12 岁时的转折点才会随着年龄的增长而增加。女孩的 TBS 明显高于男孩（p =.049），8 至 13 岁的青春期女孩的 TBS 明显高于青春期前女孩（p =.009）。TBS 年龄标准差评分（SDS-TBS）和 aBMD Z 评分呈弱相关（p < .001；R = 0.276 [男性]，R = 0.284 [女性]）。除了 aBMD Z 评分外，SDS-TBS 不受年龄调整身高 Z 评分的影响，使用粗大运动功能分类系统（GMFCS）按运动能力水平分组时，SDS-TBS 无显著差异。我们的结果表明，脑瘫患儿的骨小梁微观结构均匀分布与对照组相似。青春期启动似乎是 TBS 随年龄增长而增加和性别差异的关键。与 aBMD 相比，TBS 受身体成分、身高和活动能力的影响较小。© 2020 美国骨与矿物研究协会出版的《骨与矿物研究杂志》作者。
