Abstract
Two-dimensional dual-energy X-ray absorptiometry (DXA, osteodensitometry) is currently considered as the gold standard for diagnosis of osteoporosis. However, despite good operational characteristics, this type of investigation cannot help to assess bone microarchitecture and the degree of its derangement in osteoporosis. Therefore, trabecular bone score (TBS) has been developed as a non-invasive method of indirect description of bone microarchitecture based on data derived from a standard DXA of the lumbar spine. Not being a direct mapping of the physical measurements of trabecular microarchitecture, TBS nevertheless shows a positive correlation with quantitative values obtained from micro-computed tomography and high resolution peripheral quantitative computed tomography, i.e. with the bone volume fraction, junction density, trabecular numbers and their disintegration. There is also an association between the ability of the bone tissue to resist stress in experimental studies ex vivo and TBS measurement. Due to TBS, there is a possibility to detect bone microarchitecture impairment even in individuals with normal bone mineral density (BMD), i.e. higher TBS values correlate with improved bone microstructure, whereas a reduced TBS shows its deterioration. Limitation of TBS use are primarily related to the DXA image quality: image faults caused either by technical reasons or by too low or too high body mass index can lead to an overestimation/underestimation of the index. Assessment of the lumbar TBS has been repeatedly performed in cross-sectional and prospective studies in representative patient samples (mainly postmenopausal women) and significant numbers of healthy subjects, and proved to be a predictor (independent of BMD) of fracture risk. An evaluation of the possibility to use TBS for early diagnosis of secondary osteoporosis (related to various endocrine disorders) would be of great interest, as BMD, as known from clinical practice, is not always a reliable measurement of the bone endurance, especially in diabetes, steroid osteoporosis and acromegaly. The use of TBS along with BMD as a marker of efficacy of current treatment for secondary osteoporosis is also possible, but it is not yet evidence-based; therefore, research has to be continued.
Highlights
На сегодняшний день «золотым стандартом» диагностики остеопороза является двухэнергетическая рентгеновская абсорбциометрия
Effects of zoledronate versus placebo on spine bone mineral density and microarchitecture assessed by the trabecular bone score in postmenopausal women with osteoporosis: a three-year study
A retrospective case-control study assessing the role of trabecular bone score in postmenopausal Caucasian women with osteopenia: analyzing the odds of vertebral fracture
Summary
Обсуждая ограничения ТКИ, в первую очередь необходимо уделить внимание дегенеративным заболеваниям позвоночника. Где суммированы результаты проспективных исследований возможностей ТКИ для предсказания риска переломов [45], все исследования доказали, что ТКИ является предиктором риска переломов у женщин в постменопаузе [34, 35, 46, 47]. Согласно данным исследования Manitoba [34], у пациенток с повторными остеопоротическими переломами, переломами тел позвонков и переломами бедра отмечались значимо более низкие ТКИ и МПК (p для всех < 0,0001) в целом, чем у женщин без переломов. Для прогнозирования повторных остеопоротических переломов с клиническими проявлениями диагностические возможности ТКИ были значимо лучше, чем у МПК поясничного отдела позвоночника, но аналогичны МПК в проксимальном отделе бедра и шейке бедра. Основные результаты проспективных исследований возможностей трабекулярного костного индекса для предсказания переломов (адаптировано из B.C. Silva и соавт., 2014 [45])
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