Abstract
The consolidated way of diagnosing and treating osteoporosis in order to prevent fragility fractures has recently been questioned by some papers, which complained of overdiagnosis and consequent overtreatment of this pathology with underestimating other causes of the fragility fractures, like falls. A new clinical approach is proposed for identifying the subgroup of patients prone to fragility fractures.This retrospective observational study was conducted from January to June 2015 at the Nuclear Medicine-Bone Metabolic Unit of the of the Fondazione IRCCS Ca' Granda, Milan, Italy. An Italian population of 125 consecutive postmenopausal women was investigated for bone quantity and bone quality. Patients with neurological diseases regarding balance and vestibular dysfunction, sarcopenia, past or current history of diseases and use of drugs known to affect bone metabolism were excluded. Dual X-ray absorptiometry was used to assess bone quantity (bone mineral density) and bone quality (trabecular bone score and bone strain). Biochemical markers of bone turnover (type I collagen carboxy-terminal telopeptide, alkaline phosphatase, vitamin D) have been measured. Morphometric fractures have been searched by spine radiography. Balance was evaluated by the Romberg test. The data were evaluated with the neural network analysis using the Auto Contractive Map algorithm. The resulting semantic map shows the Minimal Spanning Tree and the Maximally Regular Graph of the interrelations between bone status parameters, balance conditions and fractures of the studied population. A low fracture risk seems to be related to a low carboxy-terminal cross-linking telopeptide of type I collagen level, whereas a positive Romberg test, together with compromised bone trabecular microarchitecture DXA parameters, appears to be strictly connected with fragility fractures. A simple assessment of the risk of fragility fracture is proposed in order to identify those frail patients at risk for osteoporotic fractures, who may have the best benefit from a pharmacological and physiotherapeutic approach.
Highlights
Osteoporosis (OP) is a pathological condition in which a reduction in bone mass and an impairment of microarchitecture are found
Diagnosis of OP and follow-up of its treatment are performed by dual X-ray photon absorptiometry (DXA), measuring areal bone mineral density, which is considered the most accurate diagnosing method, being aBMD the main parameter reflecting bone strength[7]
A new tool derived from DXA by a specific software has been developed, called trabecular bone score (TBS), which is able through a numerical value to give insight to the microarchitectural condition of vertebral bone
Summary
Osteoporosis (OP) is a pathological condition in which a reduction in bone mass and an impairment of microarchitecture are found. Vertebral fractures, which are the most frequent but less dangerous osteoporotic fractures, are directly related to a high risk of subsequent fractures[5,6]. Following the indications of International Societies [8], the densitometric scans are obtained from lumbar spine and proximal femur, which are the bone segments more frequently affected by osteoporotic “fragility” fractures, that means occurring with minimal or no trauma at all. A new tool derived from DXA by a specific software has been developed, called trabecular bone score (TBS), which is able through a numerical value to give insight to the microarchitectural condition of vertebral bone. Studies have shown its ability to predict the risk of fragility fractures in OP without relation to BMD[9,10,11,12,13,14,15,16,17,18,19,20]
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