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Abstract
Vertebral fractures are one of the most common fractures associated with skeletal fragility and can cause as much morbidity as hip fractures. However, the epidemiology of vertebral fractures differs from that of osteoporotic fractures at other skeletal sites in important ways, largely because only one quarter to one-third of vertebral fractures are recognized clinically at the time of their occurrence and otherwise require lateral spine imaging to be recognized. This article first reviews the prevalence and incidence of clinical and radiographic vertebral fractures in populations across the globe and secular trends in the incidence of vertebral fracture over time. Next, associations of vertebral fractures with measures of bone mineral density and bone microarchitecture are reviewed followed by associations of vertebral fracture with various textural measures of trabecular bone, including trabecular bone score. Finally, the article reviews clinical risk factors for vertebral fracture and the association of vertebral fractures with morbidity, mortality, and other subsequent adverse health outcomes.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center, Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MD, USA.
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102
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Nielsen BR, Linneberg A, Christensen K, Schwarz P. Perceived age is associated with bone status in women aged 25-93 years. AGE (DORDRECHT, NETHERLANDS) 2015; 37:106. [PMID: 26486892 PMCID: PMC5005844 DOI: 10.1007/s11357-015-9842-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
Higher perceived age (PA) is reported to be associated with age-related diseases. Because osteoporosis is considered an age-related disease, we hypothesized that age perceived from photographs is associated with bone mineral density (BMD)/trabecular bone score (TBS) when controlled for chronological age. This is a cross-sectional study of 460 women aged 25-93 years. BMD/TBS was measured. Twenty physicians assessed age from facial and whole-body photographs. Residual PA (R(PACA)) was calculated from the regression of PA on chronological age. Participants were divided into "looking old" (LO) or "looking young" (LY). Linear mixed models and general linear models fitted with BMD/TBS as outcome and either R(PACA) or LO/LY as an independent variable, considering chronological age. Estimates of R(PACA) were all negative; i.e., an increase in R(PAC) is associated with lower BMD, consistent with the hypothesis (e.g., β -0.29%; 95% confidence interval (CI) 0.55, 0.03). Statistical significance of the association of age-adjusted facial R(PACA) with BMD was found. Adjusted for body mass index (BMI), menopause, and hormone replacement therapy, higher R(PACA) from all photographic presentations were significantly associated with lower BMD based on statistical significance. BMD/TBS was in all analyses higher in the group LY compared with LO, when adjusted for age and BMI (e.g., β 4.37%; 95 CI 0.62, 8.26), but statistical significance was obtained only from the BMD analyses. A higher PA was significantly associated with a lower BMD/TBD, and the size of association in older women indicates that it might have value as part of the clinical assessment of osteoporotic risk.
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Affiliation(s)
- Barbara Rubek Nielsen
- Research Centre of Ageing and Osteoporosis, Departments of Endocrinology PE and Clinical Biochemistry, Rigshospitalet, Blegdamsvej and Glostrup, Copenhagen, Denmark.
- Department of Medicine, Geriatrics, Amager and Hvidovre Hospital Glostrup, Ndr. Ringvej 69 (North), 2600, Glostrup, Denmark.
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen, Denmark
- Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kaare Christensen
- Danish Research Centre of Ageing, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Peter Schwarz
- Research Centre of Ageing and Osteoporosis, Departments of Endocrinology PE and Clinical Biochemistry, Rigshospitalet, Blegdamsvej and Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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103
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Kim D, Cho SK, Kim JY, Choi YY, Sung YK. Association between trabecular bone score and risk factors for fractures in Korean female patients with rheumatoid arthritis. Mod Rheumatol 2015; 26:540-5. [PMID: 26418481 DOI: 10.3109/14397595.2015.1101212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify the association between trabecular bone score (TBS) and other known risk factors for fractures in rheumatoid arthritis (RA) patients. METHODS One hundred female RA patients aged ≥50 years were enrolled. The following risk factors for fracture were selected: prevalent vertebral fracture (VF), bone mineral density (BMD), TBS, and 10-year probability of major osteoporotic fracture by FRAX® (MOF-FRAX scores). The associations between risk factors were identified, and accuracy of TBS, BMD, and FRAX scores to detect the prevalent VF, the strongest risk factor for future fracture, were assessed. RESULTS Twenty-six patients were revealed to have moderate to severe VFs. There was a modest negative correlation between MOF-FRAX score and TBS (r = -0.367, p < 0.01), while there was no correlation between MOF-FRAX score and L-spine BMD (r = -0.050, p = 0.62). The areas under curves (AUCs) were 0.818, 0.683, and 0.518 for the MOF-FRAX score, TBS, and L-spine BMD, respectively. Among patients with glucocorticoids (GC) use (n = 57), AUCs were 0.762, 0.758, and 0.448 for their MOF-FRAX score, TBS, and L-spine BMD, respectively. CONCLUSIONS TBS showed better correlation with MOF-FRAX score than BMD, and it was superior to BMD in identifying prevalent VFs in RA patients, especially who are in use of GCs.
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Affiliation(s)
- Dam Kim
- a Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Republic of Korea .,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , Republic of Korea , and
| | - Soo-Kyung Cho
- a Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Republic of Korea .,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , Republic of Korea , and
| | - Ji Young Kim
- c Department of Nuclear Medicine , Hanyang University Hospital , Seoul , Republic of Korea
| | - Yun Young Choi
- c Department of Nuclear Medicine , Hanyang University Hospital , Seoul , Republic of Korea
| | - Yoon-Kyoung Sung
- a Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Republic of Korea .,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , Republic of Korea , and
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104
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Muschitz C, Kocijan R, Haschka J, Pahr D, Kaider A, Pietschmann P, Hans D, Muschitz GK, Fahrleitner-Pammer A, Resch H. TBS reflects trabecular microarchitecture in premenopausal women and men with idiopathic osteoporosis and low-traumatic fractures. Bone 2015; 79:259-66. [PMID: 26092650 DOI: 10.1016/j.bone.2015.06.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/19/2015] [Accepted: 06/10/2015] [Indexed: 11/15/2022]
Abstract
Transiliac bone biopsies, while widely considered to be the standard for the analysis of bone microstructure, are typically restricted to specialized centers. The benefit of Trabecular Bone Score (TBS) in addition to areal bone mineral density (aBMD) for fracture risk assessment has been documented in cross-sectional and prospective studies. The aim of this study was to test if TBS may be useful as a surrogate to histomorphometric trabecular parameters of transiliac bone biopsies. Transiliac bone biopsies from 80 female patients (median age 39.9 years-interquartile range, IQR 34.7; 44.3) and 43 male patients (median age 42.7 years-IQR 38.9; 49.0) with idiopathic osteoporosis and low traumatic fractures were included. Micro-computed tomography values of bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), structural model index (SMI) as well as serum bone turnover markers (BTMs) sclerostin, intact N-terminal type 1 procollagen propeptide (P1NP) and cross-linked C-telopeptide (CTX) were investigated. TBS values were higher in females (1.282 vs 1.169, p< 0.0001) with no differences in spine aBMD, whereas sclerostin levels (45.5 vs 33.4 pmol/L) and aBMD values at the total hip (0.989 vs 0.971 g/cm(2), p<0.001 for all) were higher in males. Multiple regression models including: gender, aBMD and BTMs revealed TBS as an independent, discriminative variable with adjusted multiple R(2) values of 69.1% for SMI, 79.5% for Tb.N, 68.4% for Tb.Sp, and 83.3% for BV/TV. In univariate regression models, BTMs showed statistically significant results, whereas in the multiple models only P1NP and CTX were significant for Tb.N. TBS is a practical, non-invasive, surrogate technique for the assessment of cancellous bone microarchitecture and should be implemented as an additional tool for the determination of trabecular bone properties.
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Affiliation(s)
- Christian Muschitz
- St. Vincent Hospital, Medical Department II, Academic Teaching Hospital of the Medical University of Vienna, Austria.
| | - Roland Kocijan
- St. Vincent Hospital, Medical Department II, Academic Teaching Hospital of the Medical University of Vienna, Austria
| | - Judith Haschka
- St. Vincent Hospital, Medical Department II, Academic Teaching Hospital of the Medical University of Vienna, Austria
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics and Intelligent Systems, The Medical University of Vienna, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Didier Hans
- Center of Bone Diseases, Lausanne University Hospital Switzerland
| | - Gabriela Katharina Muschitz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, The Medical University of Graz, Austria
| | - Heinrich Resch
- St. Vincent Hospital, Medical Department II, Academic Teaching Hospital of the Medical University of Vienna, Austria
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105
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Bazzocchi A, Ponti F, Diano D, Amadori M, Albisinni U, Battista G, Guglielmi G. Trabecular bone score in healthy ageing. Br J Radiol 2015; 88:20140865. [PMID: 26148778 DOI: 10.1259/bjr.20140865] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The main aim of this work was to report on trabecular bone score (TBS) by dual-energy X-ray absorptiometry (DXA) of healthy Italian subjects to be used as a reference standard for future study in clinical and research settings. The secondary aim was to investigate the link between TBS and conventional parameters of bone and body composition by DXA. METHODS 250 individuals of 5 age bands (spanning from 18 to 70 years of age, equally distributed for both age and sex) were prospectively recruited. A lumbar spine (LS) DXA scan (Lunar iDXA™; GE Healthcare, Madison, WI) was acquired for each subject and then analysed with the latest version of TBS iNsight v. 2.1 (Med-Imaps, Pessac, France) software. LS bone mineral density (LS BMD), Z-score, T-score and TBS values were collected. Pearson's test was used to investigate the correlations between TBS and LS BMD and the influence of age, body mass index (BMI) and body composition on these parameters. RESULTS A significant decrease of TBS and LS BMD was observed with ageing in both males (TBS mean values from 1.486 to 1.374; LS BMD mean values from 1.219 to 1.187) and females (TBS mean values from 1.464 to 1.306; LS BMD mean values from 1.154 to 1.116). No statistically significant difference was achieved among males and females of the same age group for both TBS and LS BMD, with the exception of the fifth age group. A significant correlation was found between LS BMD and TBS values in both sexes (r = 0.555-0.655, p < 0.0001). BMI influenced LS BMD but not TBS. TBS values were inversely correlated with some fat mass parameters, in particular with visceral adipose tissue (in males: r = -0.332, p < 0.001; in females: r = -0.348, p < 0.0001). No significant correlation was found between TBS and total lean mass, opposite to LS BMD (in males: r = 0.418; p < 0.0001; in females: r = -0.235; p < 0.001). CONCLUSION This report is an attempt to start building a database for healthy Italian people providing age- and sex-specific reference curves for TBS. This could help clinicians to improve patient management in the detection of impaired bone mineral status and to monitor bone changes. ADVANCES IN KNOWLEDGE The study reports TBS values of a selectively enrolled Italian healthy population, ranging from younger to older ages and including males as a reference standard. Moreover, links between body composition and TBS are explored.
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Affiliation(s)
- A Bazzocchi
- 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - F Ponti
- 2 Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - D Diano
- 2 Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - M Amadori
- 2 Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - U Albisinni
- 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - G Battista
- 2 Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Guglielmi
- 3 Department of Radiology, University of Foggia, Foggia, Italy.,4 Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
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Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi ML, Cooper C, Kendler D, Lamy O, Laslop A, Camargos BM, Reginster JY, Rizzoli R, Kanis JA. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone 2015; 78:216-24. [PMID: 25988660 PMCID: PMC4538791 DOI: 10.1016/j.bone.2015.05.016] [Citation(s) in RCA: 298] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/12/2015] [Indexed: 12/21/2022]
Abstract
Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.
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Affiliation(s)
- N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - C C Glüer
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - M-L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - D Kendler
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - O Lamy
- Bone Unit, University Hospital, Lausanne, Switzerland
| | - A Laslop
- Scientific Office, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - B M Camargos
- Unidade de Densitometria Óssea, Densimater Rede Materdei de Saúde, Belo Horizonte, MG, Brazil
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
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107
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Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score. J Clin Densitom 2015; 18:309-30. [PMID: 26277849 DOI: 10.1016/j.jocd.2015.06.008] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 12/29/2022]
Abstract
Bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for the diagnosis and management of osteoporosis. However, BMD explains only 60%-80% of bone strength, and a number of skeletal features other than BMD contribute to bone strength and fracture risk. Advanced imaging modalities can assess some of these skeletal features, but compared to standard DXA, these techniques have higher costs and limited accessibility. A major challenge, therefore, has been to incorporate in clinical practice a readily available, noninvasive technology that permits improvement in fracture-risk prediction beyond that provided by the combination of standard DXA measurements and clinical risk factors. To this end, trabecular bone score (TBS), a gray-level textural index derived from the lumbar spine DXA image, has been investigated. The purpose of this International Society for Clinical Densitometry task force was to review the evidence and develop recommendations on how to incorporate TBS in clinical practice. Clinical applications of TBS for fracture risk assessment, treatment initiation, monitoring of treatment, and use of TBS in special conditions related to greater fracture risk, were addressed. We present the official positions approved by an expert panel following careful review of the recommendations and evidence presented by the TBS task force.
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Affiliation(s)
- Barbara C Silva
- Endocrinology Division, Department of Medicine, Santa Casa and Felicio Rocho Hospital, and UNI-BH, Belo Horizonte, Minas Gerais, Brazil.
| | - Susan B Broy
- Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA
| | | | - John T Schousboe
- Park Nicollet Clinic, HealthPartners, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
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109
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Iki M, Fujita Y, Tamaki J, Kouda K, Yura A, Sato Y, Moon JS, Winzenrieth R, Okamoto N, Kurumatani N. Trabecular bone score may improve FRAX® prediction accuracy for major osteoporotic fractures in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Osteoporos Int 2015; 26:1841-8. [PMID: 25752623 DOI: 10.1007/s00198-015-3092-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/25/2015] [Indexed: 01/28/2023]
Abstract
UNLABELLED FRAX® is widely used to evaluate fracture risk of individuals in clinical settings. However, FRAX® prediction accuracy is not sufficient, and improvement is desired. Trabecular bone score, a bone microarchitecture index, may improve FRAX® prediction accuracy for major osteoporotic fractures in community-dwelling elderly Japanese men. INTRODUCTION To improve fracture risk assessment in clinical settings, we evaluated whether the combination of FRAX® and Trabecular Bone Score (TBS) improves the prediction accuracy of major osteoporotic fractures (MOFs) in elderly Japanese men compared to FRAX® alone. METHODS Two thousand and twelve community-dwelling men aged ≥65 years completed the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Baseline Study comprising lumbar spine (LS) and femoral neck areal bone mineral density (aBMD) measurements, and interviews regarding clinical risk factors required to estimate 10-year risk of MOF (hip, spine, distal forearm, and proximal humerus) using the Japanese version of FRAX® (v.3.8). TBS was calculated for the same vertebrae used for LS-aBMD with TBS iNsight software (v.2.1). MOFs that occurred during the follow-up period were identified by interviews or mail and telephone surveys. Prediction accuracy of a logistic model combining FRAX® score and TBS compared to FRAX® alone was evaluated by area under receiver-operating characteristic curves (AUCs), as well as category-free integrated discrimination improvement (IDI) and net reclassification improvement (NRI). RESULTS We identified 22 men with MOFs during 8140 person-years (PY) of follow-up among 1872 men; 67 men who suffered from fractures other than MOFs were excluded. Participants with MOFs had significantly lower TBS (p = 0.0015) and higher FRAX® scores (p = 0.0089) than those without. IDI and NRI showed significant improvements in reclassification accuracy using FRAX® plus TBS compared to FRAX® alone (IDI 0.006 (p = 0.0362), NRI 0.452 (p = 0.0351)), although no difference was observed in AUCs between the two. CONCLUSIONS TBS may improve MOF prediction accuracy of FRAX® for community-dwelling elderly Japanese men.
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Affiliation(s)
- M Iki
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Y Fujita
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - J Tamaki
- Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - K Kouda
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - A Yura
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Y Sato
- Department of Health and Nutrition, Faculty of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui, 915-8586, Japan
| | - J-S Moon
- Department of Nursing and Medical Care, Faculty of Health Science, Kio University, 4-2-2 Umami-naka, Koryo-cho, Kita-Katsuragi-gun, Nara, 635-0832, Japan
| | - R Winzenrieth
- Med-Imaps, Hôpital Xavier Arnozan, Avenue du Haut Lévèque, Pessac, 33600, France
| | - N Okamoto
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
| | - N Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
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Wu C, Rankin EB, Castellini L, Alcudia JF, Fernandez-Alcudia J, LaGory EL, Andersen R, Rhodes SD, Wilson TLS, Mohammad KS, Castillo AB, Guise TA, Schipani E, Giaccia AJ. Oxygen-sensing PHDs regulate bone homeostasis through the modulation of osteoprotegerin. Genes Dev 2015; 29:817-31. [PMID: 25846796 PMCID: PMC4403258 DOI: 10.1101/gad.255000.114] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/11/2015] [Indexed: 12/11/2022]
Abstract
The bone microenvironment is composed of niches that house cells across variable oxygen tensions. However, the contribution of oxygen gradients in regulating bone and blood homeostasis remains unknown. Here, we generated mice with either single or combined genetic inactivation of the critical oxygen-sensing prolyl hydroxylase (PHD) enzymes (PHD1-3) in osteoprogenitors. Hypoxia-inducible factor (HIF) activation associated with Phd2 and Phd3 inactivation drove bone accumulation by modulating osteoblastic/osteoclastic cross-talk through the direct regulation of osteoprotegerin (OPG). In contrast, combined inactivation of Phd1, Phd2, and Phd3 resulted in extreme HIF signaling, leading to polycythemia and excessive bone accumulation by overstimulating angiogenic-osteogenic coupling. We also demonstrate that genetic ablation of Phd2 and Phd3 was sufficient to protect ovariectomized mice against bone loss without disrupting hematopoietic homeostasis. Importantly, we identify OPG as a HIF target gene capable of directing osteoblast-mediated osteoclastogenesis to regulate bone homeostasis. Here, we show that coordinated activation of specific PHD isoforms fine-tunes the osteoblastic response to hypoxia, thereby directing two important aspects of bone physiology: cross-talk between osteoblasts and osteoclasts and angiogenic-osteogenic coupling.
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Affiliation(s)
- Colleen Wu
- Division of Cancer and Radiation Oncology, Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA
| | - Erinn B Rankin
- Division of Cancer and Radiation Oncology, Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA; Department of Obstetrics and Gynecology, Stanford University, Stanford, California 94305, USA
| | - Laura Castellini
- Division of Cancer and Radiation Oncology, Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA
| | | | | | - Edward L LaGory
- Division of Cancer and Radiation Oncology, Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA
| | - Rebecca Andersen
- Division of Cancer and Radiation Oncology, Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA
| | - Steven D Rhodes
- Department of Anatomy and Cell Biology, Indiana School of Medicine, Indianapolis, Indiana 46202, USA; Department of Medicine, Indiana School of Medicine, Indianapolis, Indiana 46202, USA
| | - Tremika L S Wilson
- Division of Endocrinology, Department of Medicine, Indiana School of Medicine, Indianapolis, Indiana 46202, USA
| | - Khalid S Mohammad
- Department of Anatomy and Cell Biology, Indiana School of Medicine, Indianapolis, Indiana 46202, USA; Division of Endocrinology, Department of Medicine, Indiana School of Medicine, Indianapolis, Indiana 46202, USA
| | - Alesha B Castillo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California 94305, USA
| | - Theresa A Guise
- Division of Endocrinology, Department of Medicine, Indiana School of Medicine, Indianapolis, Indiana 46202, USA
| | - Ernestina Schipani
- Division of Endocrinology, Department of Medicine, Indiana School of Medicine, Indianapolis, Indiana 46202, USA
| | - Amato J Giaccia
- Division of Cancer and Radiation Oncology, Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA;
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Touvier J, Winzenrieth R, Johansson H, Roux JP, Chaintreuil J, Toumi H, Jennane R, Hans D, Lespessailles E. Fracture discrimination by combined bone mineral density (BMD) and microarchitectural texture analysis. Calcif Tissue Int 2015; 96:274-83. [PMID: 25586017 DOI: 10.1007/s00223-015-9952-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
The use of bone mineral density (BMD) for fracture discrimination may be improved by considering bone microarchitecture. Texture parameters such as trabecular bone score (TBS) or mean Hurst parameter (H) could help to find women who are at high risk of fracture in the non-osteoporotic group. The purpose of this study was to combine BMD and microarchitectural texture parameters (spine TBS and calcaneus H) for the detection of osteoporotic fractures. Two hundred and fifty five women had a lumbar spine (LS), total hip (TH), and femoral neck (FN) DXA. Additionally, texture analyses were performed with TBS on spine DXA and with H on calcaneus radiographs. Seventy-nine women had prevalent fragility fractures. The association with fracture was evaluated by multivariate logistic regressions. The diagnostic value of each parameter alone and together was evaluated by odds ratios (OR). The area under curve (AUC) of the receiver operating characteristics (ROC) were assessed in models including BMD, H, and TBS. Women were also classified above and under the lowest tertile of H or TBS according to their BMD status. Women with prevalent fracture were older and had lower TBS, H, LS-BMD, and TH-BMD than women without fracture. Age-adjusted ORs were 1.66, 1.70, and 1.93 for LS, FN, and TH-BMD, respectively. Both TBS and H remained significantly associated with fracture after adjustment for age and TH-BMD: OR 2.07 [1.43; 3.05] and 1.47 [1.04; 2.11], respectively. The addition of texture parameters in the multivariate models didn't show a significant improvement of the ROC-AUC. However, women with normal or osteopenic BMD in the lowest range of TBS or H had significantly more fractures than women above the TBS or the H threshold. We have shown the potential interest of texture parameters such as TBS and H in addition to BMD to discriminate patients with or without osteoporotic fractures. However, their clinical added values should be evaluated relative to other risk factors.
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Affiliation(s)
- J Touvier
- I3MTO, EA4708, Université d'Orléans, 1, Rue Porte-Madeleine, Orléans, BP 2439, 45032 Cedex 1, France,
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Iki M, Tamaki J, Sato Y, Winzenrieth R, Kagamimori S, Kagawa Y, Yoneshima H. Age-related normative values of trabecular bone score (TBS) for Japanese women: the Japanese Population-based Osteoporosis (JPOS) study. Osteoporos Int 2015; 26:245-52. [PMID: 25149857 DOI: 10.1007/s00198-014-2856-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/12/2014] [Indexed: 01/25/2023]
Abstract
UNLABELLED Trabecular bone score (TBS), a surrogate measure of bone microarchitecture, represents fracture risk independently of bone density. We present normative TBS values from a representative population study of Japanese women. This database would enhance our understanding of trabecular bone microarchitecture and improve osteoporosis management. INTRODUCTION TBS is a texture parameter that quantifies local variation in gray level distribution within dual-energy X-ray absorptiometry (DXA) images of the lumbar spine. While TBS is associated with fracture risk independently of areal bone mineral density (aBMD), normative TBS values have only been reported for Caucasian women. This study provides age-specific normative values of TBS from a representative sample of Japanese women. METHODS We randomly selected 4,550 women aged 15-79 years from 7 areas throughout Japan. Women younger than 20 years and those with any medical history which might affect bone metabolism were excluded, and the remaining 3,069 with at least two assessable vertebrae from the first to the fourth vertebrae were subjected to analysis. TBS values were calculated from spine DXA images using TBS iNsight software (Med-Imaps, France). Age-related models of TBS were constructed using piecewise linear regression analysis. RESULTS Participant age, body mass index (BMI), spine aBMD, and TBS (mean ± SD) were 48.7 ± 16.8 years, 22.9 ± 3.4, 0.888 ± 0.169 g/cm(2), and 1.187 ± 0.137, respectively. A three-piece linear regression model of TBS on age explained 70.7% of the total variance in TBS and comprised very small age-related changes in the youngest segment of the regression line, rapid loss in the middle segment, and small loss in the oldest segment. TBS was lower in Japanese women than in Caucasian women across all age ranges, with the difference increasing with age up through 65 years. CONCLUSIONS The normative values of TBS for Japanese women presented here would enhance our understanding of trabecular bone microarchitecture and help improve the management of osteoporosis.
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Affiliation(s)
- M Iki
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan,
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Koumakis E, Avouac J, Winzenrieth R, Toth E, Payet J, Kahan A, Allanore Y, Cormier C. Trabecular bone score in female patients with systemic sclerosis: comparison with rheumatoid arthritis and influence of glucocorticoid exposure. J Rheumatol 2014; 42:228-35. [PMID: 25448793 DOI: 10.3899/jrheum.140752] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is associated with an increased risk of osteoporosis and fractures. To date, the etiology of bone loss in SSc is unclear. Trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of areal bone mineral density (aBMD). The aims were to assess bone involvement in SSc using TBS in comparison with a "high-risk" population with rheumatoid arthritis (RA) and controls, and to investigate the determinants of a low TBS. METHODS This was a cross-sectional study of 65 women with SSc, 138 age-matched female patients with RA, and 227 age-matched female controls. Spine and hip aBMD were assessed using dual-energy X-ray absorptiometry. TBS was calculated from the anteroposterior image of the spine aBMD. RESULTS TBS was significantly lower in SSc compared to controls (p < 0.0001) and did not differ from RA (p = 0.128), despite lower cumulative and daily glucocorticoid (GC) dose (p < 0.0001). Further, patients with SSc receiving GC ≥ 5 mg/day had a significantly lower TBS than those receiving GC < 5 mg/day (p = 0.001). Multivariate analysis revealed that a low TBS was independently associated with daily GC dose (OR 5.6, 95% CI 1.7-19.2) and a T score ≤ -2.5 SD (OR 5.0, 95% CI 1.5-7.0) in SSc. No association between GC and TBS was found in RA. CONCLUSION Our results support the development of a combined approach using both TBS and aBMD for the assessment of bone microarchitecture in inflammatory rheumatic diseases. Our study showed that SSc-related bone involvement is characterized by an impairment in bone quality in addition to reduced bone quantity, and highlights that TBS can identify the negative effect of GC on bone microarchitecture.
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Affiliation(s)
- Eugénie Koumakis
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Jérôme Avouac
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Renaud Winzenrieth
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Emese Toth
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Judith Payet
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - André Kahan
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Yannick Allanore
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Catherine Cormier
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
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Ayoub ML, Maalouf G, Bachour F, Barakat A, Cortet B, Legroux-Gérot I, Zunquin G, Theunynck D, Nehme A, El Hage R. DXA-based variables and osteoporotic fractures in Lebanese postmenopausal women. Orthop Traumatol Surg Res 2014; 100:855-8. [PMID: 25459457 DOI: 10.1016/j.otsr.2014.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/12/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to assess DXA-based variables (bone mineral density, bone mineral apparent density, compressive strength index of the femoral neck and trabecular bone score) in Lebanese postmenopausal women having presented a previous fracture. MATERIALS AND METHODS One thousand Lebanese postmenopausal women between 45 and 89 years participated in this study. The women were recruited by advertisements offering bone mineral density measurements at a reduced cost. Subjects with previous history of radiotherapy or chemotherapy were excluded. Informed written consent was obtained from all the participants. RESULTS Femoral neck compressive strength index (FN CSI) was significantly (P<0.001) associated with the presence of fracture using a simple logistic regression (odds ratio=0.51 [0.385-0.653]). When a multivariate logistic regression analysis was performed with the presence of fracture as a dependent variable and each of age, FN BMD and FN CSI as independent variables, only FN BMD (P=0.005) and FN CSI (P=0.004) were found to be associated with the presence of fracture. CONCLUSION This study suggests that FN CSI is associated with history of osteoporotic fractures in postmenopausal women. The use of FN CSI in clinical practice may help to identify patients with high risk of fracture. LEVEL OF EVIDENCE Epidemiological study, level IV.
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Affiliation(s)
- M-L Ayoub
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon
| | - G Maalouf
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - F Bachour
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - A Barakat
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - B Cortet
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - I Legroux-Gérot
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - G Zunquin
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - D Theunynck
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - A Nehme
- Department of Orthopedic Surgery and Traumatology, Saint-Georges University Medical Center, University of Balamand, P.O. Box 166378, Achrafieh, 1100 2807 Beirut, Lebanon
| | - R El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon.
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115
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Ulivieri FM, Silva BC, Sardanelli F, Hans D, Bilezikian JP, Caudarella R. Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine 2014; 47:435-48. [PMID: 24853880 DOI: 10.1007/s12020-014-0280-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/25/2014] [Indexed: 12/17/2022]
Abstract
Altered bone micro-architecture is an important factor in accounting for fragility fractures. Until recently, it has not been possible to gain information about skeletal microstructure in a way that is clinically feasible. Bone biopsy is essentially a research tool. High-resolution peripheral Quantitative Computed Tomography, while non-invasive, is available only sparsely throughout the world. The trabecular bone score (TBS) is an imaging technology adapted directly from the Dual Energy X-Ray Absorptiometry (DXA) image of the lumbar spine. Thus, it is potentially readily and widely available. In recent years, a large number of studies have demonstrated that TBS is significantly associated with direct measurements of bone micro-architecture, predicts current and future fragility fractures in primary osteoporosis, and may be a useful adjunct to BMD for fracture detection and prediction. In this review, we summarize its potential utility in secondary causes of osteoporosis. In some situations, like glucocorticoid-induced osteoporosis and in diabetes mellitus, the TBS appears to out-perform DXA. It also has apparent value in numerous other disorders associated with diminished bone health, including primary hyperparathyroidism, androgen-deficiency, hormone-receptor positive breast cancer treatment, chronic kidney disease, hemochromatosis, and autoimmune disorders like rheumatoid arthritis. Further research is both needed and warranted to more clearly establish the role of TBS in these and other disorders that adversely affect bone.
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Affiliation(s)
- Fabio M Ulivieri
- Bone Metabolic Unit, Division of Nuclear Medicine, Fondazione Irccs Ca' Ospedale Maggiore Policlinico, Milan, Italy
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116
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Leib E, Winzenrieth R, Lamy O, Hans D. Comparing bone microarchitecture by trabecular bone score (TBS) in Caucasian American women with and without osteoporotic fractures. Calcif Tissue Int 2014; 95:201-8. [PMID: 24948332 DOI: 10.1007/s00223-014-9882-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
Several cross-sectional studies have shown the ability of the TBS to discriminate between those with and without fractures in European populations. The aim of this study was to assess the ability of TBS to discriminate between those with and without fractures in a large female Caucasian population in the USA. This was a case-control study of 2,165 Caucasian American women aged 40 and older. Patients with illness or taking medications known to affect bone metabolism were excluded. Those in the fracture group (n = 289) had at least one low-energy fracture. BMD was measured at L1-L4, TBS calculated directly from the same DXA image. Descriptive statistics and inferential tests for difference were used. Univariate and multivariate logistic regression models were created to investigate possible association between independent variables and the status of fracture. Odds ratios per standard deviation decrease (OR) and areas under the ROC curve were calculated for discriminating parameters. Weak correlations were observed between TBS and BMD and between TBS and BMI (r = 0.33 and -0.17, respectively, p < 0.01). Mean age, weight, BMD and TBS were significantly different between control and fracture groups (all p ≤ 0.05), whereas no difference was noted for BMI or height. After adjusting for age, weight, BMD, smoking, and maternal and family history of fracture, TBS (but not BMD) remained a significant predictor of fracture: OR 1.28[1.13-1.46] even after adjustment. In a US female population, TBS again was able to discriminate between those with and those without fractures, even after adjusting for other clinical risk factors.
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Affiliation(s)
- E Leib
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
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117
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Leslie WD, Johansson H, Kanis JA, Lamy O, Oden A, McCloskey EV, Hans D. Lumbar spine texture enhances 10-year fracture probability assessment. Osteoporos Int 2014; 25:2271-7. [PMID: 24951032 DOI: 10.1007/s00198-014-2761-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/28/2014] [Indexed: 11/27/2022]
Abstract
UNLABELLED We found that lumbar spine texture analysis using trabecular bone score (TBS) is a risk factor for MOF and a risk factor for death in a retrospective cohort study from a large clinical registry for the province of Manitoba, Canada. INTRODUCTION FRAX® estimates the 10-year probability of major osteoporotic fracture (MOF) using clinical risk factors and femoral neck bone mineral density (BMD). Trabecular bone score (TBS), derived from texture in the spine dual X-ray absorptiometry (DXA) image, is related to bone microarchitecture and fracture risk independently of BMD. Our objective was to determine whether TBS provides information on MOF probability beyond that provided by the FRAX variables. METHODS We included 33,352 women aged 40-100 years (mean 63 years) with baseline DXA measurements of lumbar spine TBS and femoral neck BMD. The association between TBS, the FRAX variables, and the risk of MOF or death was examined using an extension of the Poisson regression model. RESULTS During the mean of 4.7 years, 1,754 women died and 1,872 sustained one or more MOF. For each standard deviation reduction in TBS, there was a 36 % increase in MOF risk (HR 1.36, 95 % CI 1.30-1.42, p < 0.001) and a 32 % increase in death (HR 1.32, 95 % CI 1.26-1.39, p < 0.001). When adjusted for significant clinical risk factors and femoral neck BMD, lumbar spine TBS was still a significant predictor of MOF (HR 1.18, 95 % CI 1.12-1.23) and death (HR 1.20, 95 % CI 1.14-1.26). Models for estimating MOF probability, accounting for competing mortality, showed that low TBS (10th percentile) increased risk by 1.5-1.6-fold compared with high TBS (90th percentile) across a broad range of ages and femoral neck T-scores. CONCLUSIONS Lumbar spine TBS is able to predict incident MOF independent of FRAX clinical risk factors and femoral neck BMD even after accounting for the increased death hazard.
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Affiliation(s)
- W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,
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Bandeira F, Cusano NE, Silva BC, Cassibba S, Almeida CB, Machado VCC, Bilezikian JP. Bone disease in primary hyperparathyroidism. ACTA ACUST UNITED AC 2014; 58:553-61. [DOI: 10.1590/0004-2730000003381] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/26/2014] [Indexed: 11/22/2022]
Abstract
Bone disease in severe primary hyperparathyroidism (PHPT) is described classically as osteitis fibrosa cystica (OFC). Bone pain, skeletal deformities and pathological fractures are features of OFC. Bone mineral density is usually extremely low in OFC, but it is reversible after surgical cure. The signs and symptoms of severe bone disease include bone pain, pathologic fractures, proximal muscle weakness with hyperreflexia. Bone involvement is typically characterized as salt-and-pepper appearance in the skull, bone erosions and bone resorption of the phalanges, brown tumors and cysts. In the radiography, diffuse demineralization is observed, along with pathological fractures, particularly in the long bones of the extremities. In severe, symptomatic PHPT, marked elevation of the serum calcium and PTH concentrations are seen and renal involvement is manifested by nephrolithiasis and nephrocalcinosis. A new technology, recently approved for clinical use in the United States and Europe, is likely to become more widely available because it is an adaptation of the lumbar spine DXA image. Trabecular bone score (TBS) is a gray-level textural analysis that provides an indirect index of trabecular microarchitecture. Newer technologies, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), have provided further understanding of the microstructural skeletal features in PHPT.
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Senn C, Günther B, Popp AW, Perrelet R, Hans D, Lippuner K. Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study. Osteoporos Int 2014; 25:1945-51. [PMID: 24760244 DOI: 10.1007/s00198-014-2703-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/25/2014] [Indexed: 01/23/2023]
Abstract
UNLABELLED Treatment effects over 2 years of teriparatide vs. ibandronate in postmenopausal women with osteoporosis were compared using lumbar spine bone mineral density (BMD) and trabecular bone score (TBS). Teriparatide induced larger increases in BMD and TBS compared to ibandronate, suggesting a more pronounced effect on bone microarchitecture of the bone anabolic drug. INTRODUCTION The trabecular bone score (TBS) is an index of bone microarchitecture, independent of bone mineral density (BMD), calculated from anteroposterior spine dual X-ray absorptiometry (DXA) scans. The potential role of TBS for monitoring treatment response with bone-active substances is not established. The aim of this study was to compare the effects of recombinant human 1-34 parathyroid hormone (teriparatide) and the bisphosphonate ibandronate (IBN), on lumbar spine (LS) BMD and TBS in postmenopausal women with osteoporosis. METHODS Two patient groups with matched age, body mass index (BMI), and baseline LS BMD, treated with either daily subcutaneous teriparatide (N = 65) or quarterly intravenous IBN (N = 122) during 2 years and with available LS BMD measurements at baseline and 2 years after treatment initiation were compared. RESULTS Baseline characteristics (overall mean ± SD) were similar between groups in terms of age 67.9 ± 7.4 years, body mass index 23.8 ± 3.8 kg/m(2), BMD L1-L4 0.741 ± 0.100 g/cm(2), and TBS 1.208 ± 0.100. Over 24 months, teriparatide induced a significantly larger increase in LS BMD and TBS than IBN (+7.6 % ± 6.3 vs. +2.9 % ± 3.3 and +4.3 % ± 6.6 vs. +0.3 % ± 4.1, respectively; P < 0.0001 for both). LS BMD and TBS were only weakly correlated at baseline (r (2) = 0.04) with no correlation between the changes in BMD and TBS over 24 months. CONCLUSIONS In postmenopausal women with osteoporosis, a 2-year treatment with teriparatide led to a significantly larger increase in LS BMD and TBS than IBN, suggesting that teriparatide had more pronounced effects on bone microarchitecture than IBN.
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Affiliation(s)
- C Senn
- Department of Osteoporosis, Inselspital, Berne University Hospital and University of Berne, CH-3010, Berne, Switzerland
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Silva BC, Bilezikian JP. Trabecular bone score: perspectives of an imaging technology coming of age. ACTA ACUST UNITED AC 2014; 58:493-503. [DOI: 10.1590/0004-2730000003456] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
The trabecular bone score (TBS) is a new method to describe skeletal microarchitecture from the dual energy X-ray absorptiometry (DXA) image of the lumbar spine. While TBS is not a direct physical measurement of trabecular microarchitecture, it correlates with micro-computed tomography (µCT) measures of bone volume fraction, connectivity density, trabecular number, and trabecular separation, and with vertebral mechanical behavior in ex vivo studies. In human subjects, TBS has been shown to be associated with trabecular microarchitecture and bone strength by high resolution peripheral quantitative computed tomography (HRpQCT). Cross-sectional and prospective studies, involving a large number of subjects, have both shown that TBS is associated with vertebral, femoral neck, and other types of osteoporotic fractures in postmenopausal women. Data in men, while much less extensive, show similar findings. TBS is also associated with fragility fractures in subjects with secondary causes of osteoporosis, and preliminary data suggest that TBS might improve fracture prediction when incorporated in the fracture risk assessment system known as FRAX. In this article, we review recent advances that have helped to establish this new imaging technology.
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Kolta S, Briot K, Fechtenbaum J, Paternotte S, Armbrecht G, Felsenberg D, Glüer CC, Eastell R, Roux C. TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int 2014; 25:1759-64. [PMID: 24687386 DOI: 10.1007/s00198-014-2685-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED The effect of lumbar osteoarthritis on bone density and trabecular bone score (TBS) was evaluated cross-sectionally and prospectively in postmenopausal women. Lumbar spine osteoarthritis was graded according to Kellgren and Lawrence grades. Lumbar osteoarthritis was found to increase lumbar spine bone density, but not TBS. INTRODUCTION Lumbar osteoarthritis overestimates lumbar bone density (areal bone mineral density (aBMD)). A new texture parameter, the TBS, has been proposed. Calculation of aBMD uses grey level value, while TBS uses grey level variation. Therefore, our hypothesis was that TBS is not influenced by lumbar spine osteoarthritis. METHODS Menopausal women participating in osteoporosis and ultrasound (OPUS) study were included. They had an aBMD measurement of the spine and hip at baseline and 6-year visit. TBS was calculated on lumbar spine dual-energy X-ray absorptiometry (DXA) scans in an automated manner. The presence of lumbar osteoarthritis was evaluated on baseline radiographs using Kellgren and Lawrence (K&L) classification. Grades range from 0 to 4. In our study, osteoarthritis was defined by at least K&L grade 2. RESULTS This study included 1,254 menopausal women (66.7 ± 7.1 years). Among them, 727 attended the 6-year follow-up visit. Patients with lumbar osteoarthritis had an aBMD higher than those without lumbar osteoarthritis at the lumbar spine, but not at the hip. However, the aBMD significantly increased in all sites with the grade of K&L. In contrast, spine TBS was not different between patients with and without lumbar osteoarthritis (p = 0.70), and it was not correlated with K&L grade. Spine TBS and aBMD at all sites were negatively correlated with age (p < 0.0001). Body mass index was correlated positively with aBMD and negatively with spine TBS (p < 0.0001). The 6-year change of aBMD was significant in the hip and nonsignificant in the lumbar spine. That of TBS was significant, with a 3.3 % decrease (p < 0.0001), independent of K&L grade (p = 0.28). CONCLUSION In postmenopausal women, lumbar osteoarthritis leads to an increase in lumbar spine aBMD. In contrast, spine TBS is not affected by lumbar osteoarthritis.
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Affiliation(s)
- S Kolta
- INSERM, U 1153, Rheumatology Department, Cochin Hospital, Paris Descartes University, Paris, France,
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Iki M, Tamaki J, Sato Y, Morita A, Ikeda Y, Kajita E, Nishino H, Akiba T, Matsumoto T, Kagamimori S, Kagawa Y, Yoneshima H, Matsukura T, Yamagami T, Kitagawa J. Cohort Profile: The Japanese Population-based Osteoporosis (JPOS) Cohort Study. Int J Epidemiol 2014; 44:405-14. [DOI: 10.1093/ije/dyu084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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