Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States of America.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, Crabtree Hall A547, 130 DeSoto Street, Pittsburgh, PA, 15261, United States of America.
Bone. 2020 Nov;140:115543. doi: 10.1016/j.bone.2020.115543. Epub 2020 Jul 27.
Evidence that trabecular bone score (TBS), an index of bone microstructure, is a risk factor for future fracture comes mainly from studies of late postmenopausal women.
To discern whether premenopausal TBS or early postmenopausal TBS predict fracture.
A 22-year, prospective analysis from the Study of Women's Health Across Nation.
Community-based cohort.
272 Black, 174 Japanese, and 364 White women.
Incident fractures: 292 in premenopausal sample and 141 in early postmenopausal sample.
Separate Cox proportional hazard regressions modeled time to incident fracture as a function of TBS measured during premenopause or early postmenopause. Models were initially adjusted for age, race/ethnicity, SWAN clinical site, body mass index, use of calcium, vitamin D, bone beneficial or bone adverse medication. Next, we added lumbar spine (LS) or femoral neck (FN) bone mineral density (BMD) and, finally, history of prior fracture, to the models. For each standard deviation decrement in premenopausal TBS, fracture hazard was elevated by 17% (relative hazard [RH] 1.17 [95% CI, 1.02-1.35]); after adjusting for LS or FN BMD, the relation between premenopausal TBS and fracture was no longer statistically significant. There was a similar-magnitude, marginally statistically significant, association between early postmenopausal TBS and fracture, unadjusted for BMD (RH 1.15 [0.95-1.39]).
Variation in premenopausal TBS is related to fracture risk, but this association is not independent of BMD.
骨小梁评分（TBS）是骨微结构的一个指数，有证据表明它是未来骨折的一个风险因素，这些证据主要来自对绝经后期妇女的研究。
探究绝经前 TBS 或早期绝经后 TBS 是否能预测骨折。
这是一项来自妇女健康倡议研究的 22 年前瞻性分析。
基于社区的队列。
272 名黑人、174 名日本人以及 364 名白人妇女。
骨折事件：在绝经前样本中发生了 292 例，在早期绝经后样本中发生了 141 例。
分别采用 Cox 比例风险回归分析，将 TBS 测量时间作为绝经前或早期绝经后发生骨折的函数。模型最初根据年龄、种族/民族、SWAN 临床站点、体重指数、钙、维生素 D、对骨骼有益或有害的药物进行调整。接下来，我们将腰椎（LS）或股骨颈（FN）骨密度（BMD）加入模型，最后，将既往骨折史加入模型。绝经前 TBS 每降低一个标准差，骨折风险增加 17%（相对风险[RH]1.17[95%CI，1.02-1.35]）；在调整 LS 或 FN BMD 后，绝经前 TBS 与骨折之间的关系不再具有统计学意义。早期绝经后 TBS 与骨折之间存在类似幅度、具有统计学意义的关联，未调整 BMD（RH 1.15[0.95-1.39]）。
绝经前 TBS 的变化与骨折风险相关，但这种关联与 BMD 无关。
