Sherman Alain E, Shokrekhuda Aspan M, Kalbi Deepak P, Bencardino Jenny T, Chun Kwang J
Resident Physician, Diagnostic Radiology, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York.
Resident Physician, Nuclear Medicine, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York.
J Am Coll Radiol. 2025 Mar;22(3):342-348. doi: 10.1016/j.jacr.2024.12.009.
Lung transplant candidates routinely undergo dual-energy x-ray absorptiometry (DXA) screening due to increased risk of osteoporosis secondary to comorbidities and prolonged immunosuppression. Nonetheless, postoperative insufficiency fractures have been well documented, even in patients with normal bone mineral density (BMD). This study investigated the added value of trabecular bone score (TBS) as a complementary screening index of bone microarchitecture.
A retrospective review of 143 lung transplant candidates who underwent preoperative DXA screening was performed. TBS was calculated from DXA of the lumbar spine. DXA and TBS measurements were standardized using T-scores with reference to established population-based datasets.
Differences in the observed rates of osteopenia (36.4%), osteoporosis (11.2%), partially degraded bone (35.0%), and degraded bone (35.0%) were statistically significant (P < .001). Abnormal trabecular microarchitecture was significantly more prevalent than abnormal BMD (69.9% versus 47.6%; P < .001). TBS T-scores (mean = -1.98, SD = 1.39) were, on average, significantly lower than DXA T-scores (mean = -0.80, SD = 1.57; t[142] = 9.09; P < .001). Hispanic patients (mean = -1.25, SD = 1.28) had significantly lower DXA T-scores compared with White (mean = -0.28, SD = 1.14) or Black patients (mean = -0.30, SD = 1.31; F[2, 109] = 8.28; P < .001). By contrast, TBS T-scores did not differ by race or ethnicity (F[2, 109] = 0.26; P = .78).
Impaired trabecular microarchitecture is extremely common among lung transplant candidates, with a substantial proportion at risk of fracture through degraded bone despite normal BMD. TBS offers promise as a simple, robust, inexpensive, and noninvasive screening adjunct to DXA in this unique and vulnerable population.
由于合并症和长期免疫抑制导致骨质疏松风险增加，肺移植候选者通常会接受双能X线吸收法（DXA）筛查。尽管如此，术后骨不全骨折已有充分记录，即使在骨矿物质密度（BMD）正常的患者中也是如此。本研究调查了小梁骨评分（TBS）作为骨微结构补充筛查指标的附加价值。
对143例接受术前DXA筛查的肺移植候选者进行回顾性研究。TBS由腰椎的DXA计算得出。DXA和TBS测量值使用T分数进行标准化，并参考既定的基于人群的数据集。
观察到的骨质减少（36.4%）、骨质疏松（11.2%）、部分骨退化（35.0%）和骨退化（35.0%）发生率差异具有统计学意义（P <.001）。小梁微结构异常比BMD异常更为普遍（69.9%对47.6%；P <.001）。TBS T分数（平均值 = -1.98，标准差 = 1.39）平均显著低于DXA T分数（平均值 = -0.80，标准差 = 1.57；t[142] = 9.09；P <.001）。西班牙裔患者（平均值 = -1.25，标准差 = 1.28）的DXA T分数显著低于白人（平均值 = -0.28，标准差 = 1.14）或黑人患者（平均值 = -0.30，标准差 = 1.31；F[2, 109] = 8.28；P <.001）。相比之下，TBS T分数在种族或民族方面没有差异（F[2, 109] = 0.26；P =.78）。
小梁微结构受损在肺移植候选者中极为常见，尽管BMD正常，但仍有很大比例的人因骨退化而有骨折风险。在这个独特且脆弱的人群中，TBS有望作为一种简单、可靠、廉价且无创的DXA筛查辅助手段。
