Hawkins Carranza Federico, Arroba Cristina Martin-Arriscado, López Alvarez María Begoña, Librizzi Soledad, Martínez Díaz Guerra Guillermo
Research Institute i+12, University Hospital 12 de Octubre, Faculty of Medicine, University Complutense, 28041 Madrid, Spain.
Research Institute i+12, University Hospital 12 de Octubre, 28041 Madrid, Spain.
Diagnostics (Basel). 2024 Apr 23;14(9):868. doi: 10.3390/diagnostics14090868.
The study of BMD provides only partial information on bone health in patients undergoing TSH suppression therapy due to differentiated thyroid cancer (DTC). The trabecular bone score (TBS), a new parameter assessing bone microarchitecture, is proposed for studying bone in this context. This study aimed to analyze their long-term use in patients with DTC.
Bone mineral density (BMD) was measured by dual X-ray densitometry (DXA) and TBS was assessed with iNsigth software (version 2.0, MediImaps, France) in 145 postmenopausal patients with DTC. Vertebral fractures (VFs) were identified using a semi-quantitative X-ray method.
The BMD at the end of this study did not differ from the initial measurement. However, the TBS decreased from 1.35 ± 0.1 to 1.27 ± 0.1 ( = 0.002). Increased levels of PTH, osteocalcin, and bone alkaline phosphatase (BAP) were observed, suggesting enhanced bone remodeling. There was an increase in the prevalence of osteoporosis and osteopenia (40.6% and 16.5% to 46.6% and 18.6%, respectively). The proportion of patients with partially degraded and totally degraded TBS increased from 31% and 15.1% to 48.9% and 24.8% by the end of this study. Among the 30 patients with VFs, there were no significant differences in age, body mass index (BMI), calcium intake, alcohol consumption, smoking, radioiodine, therapy, or thyroid parameters compared to those without VFs. The odds ratio for VFs increased with osteopenia (OR 2.63). Combining TBS with BMD did not improve discrimination.
The TBS decreased while the BMD remained unchanged. The percentage of patients with osteoporosis and osteopenia, whether partially degraded or totally degraded, increased by the end of this study. The predominant discordance was found in partially degraded microarchitectures, with a higher proportion of osteopenic patients compared to those with normal or osteoporotic bone density. The AUC of the combination of TBS and BMD did not enhance discrimination. TBS, radioactive iodine therapy, and sedentary lifestyle emerged as the main distinguishing factors for DTC patients with VFs.
对于因分化型甲状腺癌（DTC）接受促甲状腺激素抑制治疗的患者，骨密度（BMD）研究仅能提供关于骨骼健康的部分信息。小梁骨评分（TBS）是一种评估骨微结构的新参数，在此背景下被用于研究骨骼。本研究旨在分析其在DTC患者中的长期应用情况。
采用双能X线骨密度仪（DXA）测量145例绝经后DTC患者的骨密度，并使用iNsigth软件（版本2.0，法国MediImaps公司）评估TBS。采用半定量X线方法识别椎体骨折（VF）。
本研究结束时的骨密度与初始测量值无差异。然而，TBS从1.35±0.1降至1.27±0.1（P = 0.002）。观察到甲状旁腺激素、骨钙素和骨碱性磷酸酶（BAP）水平升高，提示骨重塑增强。骨质疏松症和骨质减少症的患病率有所增加（分别从40.6%和16.5%增至46.6%和18.6%）。到本研究结束时，TBS部分降低和完全降低的患者比例分别从31%和15.1%增至48.9%和24.8%。在30例椎体骨折患者中，与无椎体骨折患者相比，其年龄、体重指数（BMI）、钙摄入量、饮酒量、吸烟情况、放射性碘治疗或甲状腺参数均无显著差异。椎体骨折的比值比随骨质减少而增加（比值比2.63）。将TBS与骨密度结合使用并未提高鉴别能力。
TBS降低而骨密度保持不变。到本研究结束时，骨质疏松症和骨质减少症患者的比例，无论TBS是部分降低还是完全降低，均有所增加。主要差异在于部分降低的微结构，与骨密度正常或骨质疏松的患者相比，骨质减少患者的比例更高。TBS与骨密度结合的曲线下面积（AUC）并未增强鉴别能力。TBS、放射性碘治疗和久坐不动的生活方式是DTC椎体骨折患者的主要鉴别因素。
