Abstract
BackgroundBone mineral density (BMD) and trabecular bone score (TBS) are moderately correlated. TBS is sometimes used as an adjuvant to BMD in the fracture risk assessment. Some individuals with normal BMD or osteopenia, have more degraded TBS. We aimed to identify factors associated with TBS worse than BMD in the non-osteoporotic elderly population.MethodsThe study subjects were selected from 2384 women and men aged ≥60 years participating in the second stage of the Bushehr Elderly Health program, a population-based prospective cohort study in Iran. The BMDs of different sites and the lumbar spine texture were measured using dual-energy X-ray absorptiometry and the TBS algorithm, respectively. Subjects were categorized based on their BMD and TBS status. Logistic regression was performed to identify the factors associated with “TBS worse than BMD” in non-osteoporotic individuals.ResultsOf 1335 participants included in the study, 112 of 457 women, and 54 of 878 men had worse TBS than BMD. In multivariable analysis, TBS worse than BMD in women was statistically significantly associated with years since menopause (OR: 1.04 (1.00–1.07)) and waist circumference (OR: 1.09 (1.05–1.14)). However, in men, the condition was statistically significantly associated with waist circumference (OR: 1.10 (1.03–1.17)), current smoking (OR: 2.54 (1.10–5.84)), and HDL-C (OR: 1.03 (1.00–1.06)).ConclusionThe results of the study show that higher waist circumference is associated with more degraded TBS than BMD in both men and women. Years passed since menopause and current smoking, respectively in women and men, were associated with more degraded TBS. Considering TBS values in older individuals with higher waist circumference, or a history of smoking despite normal BMDs might help more accurate assessment of bone health. However, further studies are required to confirm the benefit.
Highlights
The diagnosis of osteoporosis is most commonly based on bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA)
We considered lipid profile including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) because there is likely to be confounding of lipid parameters with waist circumference (WC), body mass index (BMI), and/or diabetes status
After the exclusion of 948 participants with osteoporosis, 1335 non-osteoporotic elderly women and men were included in the study for further analysis
Summary
The diagnosis of osteoporosis is most commonly based on bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA). Bone strength is dependent on both bone mass and bone quality (bone geometry, micro-architecture, micro-damage, mineralization, and turnover) [1], as evidenced by the occurrence of more fragility fractures in normal BMD or osteopenic individuals than in osteoporotic ones [2, 3]. Bone mineral density (BMD) and trabecular bone score (TBS) are moderately correlated. TBS is sometimes used as an adjuvant to BMD in the fracture risk assessment. Some individuals with normal BMD or osteopenia, have more degraded TBS. We aimed to identify factors associated with TBS worse than BMD in the non-osteoporotic elderly population
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