Anabtawi A, Holyoak M, He J, Cristiano E, Polineni D, Graves L
Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail stop 2024, Kansas City, KS, 66160, USA.
Department of Biostatistics and Data Science, Medical Center, University of Kansas, Kansas City, KS, USA.
Osteoporos Int. 2022 May;33(5):1137-1145. doi: 10.1007/s00198-021-06290-x. Epub 2022 Jan 11.
People with cystic fibrosis (CF) are at increased risk of fractures. Our study found that low trabecular bone score (TBS) (a measure of bone strength) may help identify people with CF at risk of fractures especially when combined with bone density measured by DXA, age, hemoglobin A1c, and transplant status.
People with cystic fibrosis (CF) are at increased risk of fractures. This study aims to evaluate the association of trabecular bone score (TBS) with fractures in CF.
A cross-sectional study of adults with CF who completed bone density between 2009 and 2019. TBS was applied to lumbar spine studies.
A total of 202 people with CF were included. A history of fracture was present in 36 (17.8%) subjects. Patients with history of fractures had higher hemoglobin A1c (A1C) (7.8 ± 2.7% vs. 6.7 ± 1.7%, p = 0.024), lower femoral neck (FN) Z/T-score (- 1.05 ± 1.08 vs. - 0.44 ± 1.08, p = 0.012), and lower TBS (1.36 ± 0.13 vs. 1.40 ± 0.11, p = 0.05) compared to those without. Lung transplant recipients had a higher prevalence of fractures (50% vs. 14.1%, p < 0.001). The odds ratio (95%CI) of having a fracture for subjects with TBS (≤ 1.2 vs. > 1.2) stratified by FN Z/T-score (≤ - 2.0 or > - 2.0) was 3.88 (0.92, 16.35), p = 0.07. ROC analysis showed TBS was significantly associated with fractures (p < 0.05); however, FN BMD was superior. A model combining FN BMD, age, A1c, transplant, and TBS improved ROC compared to FN BMD + age (0.837 vs. 0.779, p = 0.031).
TBS ≤ 1.2 may identify people with CF at high risk of fractures. A model combining FN BMD, age, A1c, transplant, and TBS was significantly associated with fractures compared to FN BMD + age. Future studies are needed to evaluate the prediction of fractures in people with CF using clinical and bone parameters.
患有囊性纤维化（CF）的人骨折风险增加。我们的研究发现，低小梁骨评分（TBS）（一种衡量骨强度的指标）可能有助于识别有骨折风险的CF患者，特别是当与通过双能X线吸收法（DXA）测量的骨密度、年龄、糖化血红蛋白和移植状态相结合时。
患有囊性纤维化（CF）的人骨折风险增加。本研究旨在评估小梁骨评分（TBS）与CF患者骨折之间的关联。
对2009年至2019年间完成骨密度检查的成年CF患者进行横断面研究。TBS应用于腰椎研究。
共纳入202例CF患者。36例（17.8%）受试者有骨折史。有骨折史的患者糖化血红蛋白（A1C）水平较高（7.8±2.7%对6.7±1.7%，p = 0.024），股骨颈（FN）Z/T评分较低（-1.05±1.08对-0.44±1.08，p = 0.012），TBS较低（1.36±0.13对1.40±0.11，p = 0.05）。肺移植受者骨折患病率较高（50%对14.1%，p < 0.001）。根据FN Z/T评分（≤-2.0或>-2.0）分层，TBS≤1.2与>1.2的受试者发生骨折的比值比（95%CI）为3.88（0.92，16.35），p = 0.07。ROC分析显示TBS与骨折显著相关（p < 0.05）；然而，FN骨密度更佳。与FN骨密度+年龄相比，结合FN骨密度、年龄、A1C、移植和TBS的模型改善了ROC（0.837对0.779，p = 0.031）。
TBS≤1.2可能识别出骨折风险高 的CF患者。与FN骨密度+年龄相比，结合FN骨密度、年龄、A1C、移植和TBS的模型与骨折显著相关。未来需要进行研究，以评估使用临床和骨参数预测CF患者骨折的情况。
