Antonini S, Pedersini R, Birtolo M F, Baruch N L, Carrone F, Jaafar S, Ciafardini A, Cosentini D, Laganà M, Torrisi R, Farina D, Leonardi L, Balzarini L, Vena W, Bossi A C, Zambelli A, Lania A G, Berruti A, Mazziotti G
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
J Endocrinol Invest. 2024 Feb;47(2):433-442. doi: 10.1007/s40618-023-02174-5. Epub 2023 Aug 17.
Trabecular bone score (TBS) is a gray-level textural metric that has shown to correlate with risk of fractures in several forms of osteoporosis. The value of TBS in predicting fractures and the effects of bone-active drugs on TBS in aromatase inhibitors (AIs)-induced osteoporosis are still largely unknown. The primary objective of this retrospective study was to assess the effects of denosumab and bisphosphonates (BPs) on TBS and vertebral fractures (VFs) in women exposed to AIs.
241 consecutive women (median age 58 years) with early breast cancer undergoing treatment with AIs were evaluated for TBS, bone mineral density (BMD) and morphometric VFs at baseline and after 18-24 months of follow-up. During the study period, 139 women (57.7%) received denosumab 60 mg every 6 months, 53 (22.0%) BPs, whereas 49 women (20.3%) were not treated with bone-active drugs.
Denosumab significantly increased TBS values (from 1.270 to 1.323; P < 0.001) accompanied by a significant decrease in risk of VFs (odds ratio 0.282; P = 0.021). During treatment with BPs, TBS did not significantly change (P = 0.849) and incidence of VFs was not significantly different from women untreated with bone-active drugs (P = 0.427). In the whole population, women with incident VFs showed higher decrease in TBS vs. non-fractured women (P = 0.003), without significant differences in changes of BMD at any skeletal site.
TBS variation predicts fracture risk in AIs treated women. Denosumab is effective to induce early increase of TBS and reduction in risk of VFs.
小梁骨评分（TBS）是一种灰度纹理指标，已显示与多种形式骨质疏松症的骨折风险相关。TBS在预测骨折中的价值以及骨活性药物对芳香化酶抑制剂（AIs）所致骨质疏松症患者TBS的影响仍在很大程度上未知。这项回顾性研究的主要目的是评估地诺单抗和双膦酸盐（BPs）对接受AIs治疗的女性的TBS和椎体骨折（VFs）的影响。
对241例连续接受AIs治疗的早期乳腺癌女性（中位年龄58岁）在基线以及随访18 - 24个月后进行TBS、骨密度（BMD）和形态计量学椎体骨折评估。在研究期间，139例女性（57.7%）每6个月接受60 mg地诺单抗治疗，53例（22.0%）接受双膦酸盐治疗，而49例女性（20.3%）未接受骨活性药物治疗。
地诺单抗显著提高了TBS值（从1.270提高到1.323；P < 0.001），同时椎体骨折风险显著降低（优势比0.282；P = 0.021）。在双膦酸盐治疗期间，TBS没有显著变化（P = 0.849），椎体骨折发生率与未接受骨活性药物治疗的女性相比无显著差异（P = 0.427）。在整个人群中，发生椎体骨折的女性与未骨折女性相比，TBS下降幅度更大（P = 0.003），在任何骨骼部位的骨密度变化无显著差异。
TBS变化可预测接受AIs治疗女性的骨折风险。地诺单抗可有效促使TBS早期升高并降低椎体骨折风险。
