Use Of Trabecular Bone Score Research Articles

Can Trabecular Bone Score Enhance Fracture Risk Assessment in Long-Distance Runners With Bone Stress Injuries?

Objective: To evaluate the trabecular bone score (TBS) Z scores in long-distance runners with bone stress injuries (BSIs) in whom the bone mineral density (BMD) Z score is more than −1.0 (Aim 1) and whether the number of runners with abnormal TBS Z scores would be higher in those with BSI in trabecular-rich sites as compared with cortical-rich sites (Aim 2). Design: Retrospective cohort study. Setting: Institutional sports medicine center. Patients: We analyzed Z scores derived from the TBS and BMD in 44 long-distance runners aged 18 to 40 years who had sustained BSIs between 2017 and 2023 and undergone a dual-energy x-ray absorptiometry scan with reported TBS measurements within 1 year before or 2 years after their injuries. Independent Variables: Bone mineral density and TBS Z scores. Main Outcome Measures: Evaluation of BMD and TBS Z scores in long-distance runners with BSIs, further stratified according to cortical-rich and trabecular-rich BSIs. Results: Bone mineral density assessments revealed an average Z score of −0.96 ± 0.99. In this cohort of 44 runners, 55% (n = 24) of runners were reported to have BMD Z score more than −1.0. Within this subgroup, 54% (n = 13) displayed abnormal TBS. Stratifying BSIs by trabecular- (n = 23) and cortical-rich (n = 19) sites, we found no significant difference in sex, mean BMD, or the number of runners with abnormal TBS between the 2 groups. Conclusions: Trabecular bone score Z scores in sports medicine may provide complementary information to BMD in long-distance runners with BSI, particularly when the BMD Z scores are more than −1.0. However, further research is needed to validate the usefulness of TBS Z scores in this context. Study Design: Cohort study. Level of Evidence: Retrospective Case Series, IV.

Trabecular Bone Score to Enhance Fracture Risk Prediction and Treatment Strategies in Osteoporosis.

The Trabecular Bone Score (TBS), a gray-level textural assessment derived from dual-energy X-ray absorptiometry images, serves as a validated index of trabecular bone microarchitecture. Over the past decade, significant evidence has highlighted the usefulness of TBS in primary and secondary osteoporosis, leading to its integration with the Fracture Risk Assessment Tool (FRAX) and bone mineral density (BMD) T-score adjustments. This review explores the role of TBS in fracture prediction, treatment initiation, and monitoring. Studies confirm that TBS enhances fracture risk prediction in both primary and secondary osteoporosis when combined with BMD and clinical risk factors. Evidence also suggests that including TBS alongside BMD and FRAX offers significant potential for treatment stratification, considering the overall skeletal profile, such as bone mass, bone quality, and clinical risk factors. Consequently, TBS has become a standard part of clinical care worldwide. Future enhancements hope to adjust for soft tissue thickness, broadening the applicability of TBS across diverse body types and pediatric populations.

The Role of Glucose, Insulin and Body Fat in Assessment of Bone Mineral Density and Trabecular Bone Score in Women with Functional Hypothalamic Amenorrhea.

Background: For years, bone mineral density (BMD) has played a key role in assessing bone health, but the trabecular bone score (TBS) is emerging as an equivalent measure. However, BMD alone may not fully measure bone quality or predict osteoporosis risk. To evaluate the usefulness of TBS and BMD in estimating the risk of bone fracture in young women with FHA, this study examined the association between metabolic parameters and bone quality, which was measured using TBS and BMD. Methods: We analyzed the association of metabolic factors with tests assessing bone quality-TBS and BMD. Patients were checked for BMI, measured body fat, and determined serum glucose levels and insulin levels in a 75g glucose load test. Spearman correlation analysis was used. Results: Significant positive correlations were found between BMD and age (p < 0.001) and body fat (p < 0.001), as well as between TBS values and BMI (p < 0.001) and TBS and percent body fat (p < 0.001). Of the variables analyzed in the multivariate analysis, the only independent predictor of higher bone mineral density in the lumbar spine was found to be higher values of the trabecular bone index in the same segment (p < 0.001). Conclusions: The use of TBS provides a simple tool for estimating the risk of bone damage. Ultimately, early screening, diagnosis and treatment of patients with FHA may help prevent osteoporosis and fragility fractures in the long term.

Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions

Osteoporosis can currently be diagnosed by applying the WHO classification to bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA). However, skeletal factors other than BMD contribute to bone strength and fracture risk. Lumbar spine TBS, a grey-level texture measure which is derived from DXA images has been extensively studied, enhances fracture prediction independent of BMD and can be used to adjust fracture probability from FRAX® to improve risk stratification. The purpose of this International Society for Clinical Densitometry task force was to review the existing evidence and develop recommendations to assist clinicians regarding when and how to perform, report and utilize TBS. Our review concluded that TBS is most likely to alter clinical management in patients aged ≥ 40 years who are close to the pharmacologic intervention threshold by FRAX. The TBS value from L1-L4 vertebral levels, without vertebral exclusions, should be used to calculate adjusted FRAX probabilities. L1-L4 vertebral levels can be used in the presence of degenerative changes and lumbar compression fractures. It is recommended not to report TBS if extreme structural or pathological artifacts are present. Monitoring and reporting TBS change is unlikely to be helpful with the current version of the TBS algorithm. The next version of TBS software will include an adjustment based upon directly measured tissue thickness. This is expected to improve performance and address some of the technical factors that affect the current algorithm which may require modifications to these Official Positions as experience is acquired with this new algorithm.

Trabecular Bone Score (TBS) in Individuals with Type 2 Diabetes Mellitus: An Updated Review

Bone fragility is a complication of type 2 diabetes mellitus (T2DM) that has been identified in recent decades. Trabecular bone score (TBS) appears to be more accurate than bone mineral density (BMD) in diabetic bone disease, particularly in menopausal women with T2DM, to independently capture the fracture risk. Our purpose was to provide the most recent overview on TBS-associated clinical data in T2DM. The core of this narrative review is based on original studies (PubMed-indexed journals, full-length, English articles). The sample-based analysis (n = 11, N = 4653) confirmed the use of TBS in T2DM particularly in females (females/males ratio of 1.9), with ages varying between 35 and 91 (mean 65.34) years. With concern to the study design, apart from the transversal studies, two others were prospective, while another two were case-control. These early-post-pandemic data included studies of various sample sizes, such as: males and females (N of 245, 361, 511, and 2294), only women (N of 80, 96, 104, 243, 493, and 887), and only men (N = 169). Overall, this 21-month study on published data confirmed the prior profile of BMD-TBS in T2DM, while the issue of whether checking the fracture risk is mandatory in adults with uncontrolled T2DM remains to be proven or whether, on the other hand, a reduced TBS might function as a surrogate marker of complicated/uncontrolled T2DM. The interventional approach with bisphosphonates for treating T2DM-associated osteoporosis remains a standard one (n = 2). One control study on 4 mg zoledronic acid showed after 1 year a statistically significant increase of lumbar BMD in both diabetic and non-diabetic groups (+3.6%, p = 0.01 and +6.2%, p = 0.01, respectively). Further studies will pinpoint additive benefits on glucose status of anti-osteoporotic drugs or will confirm if certain glucose-lowering regimes are supplementarily beneficial for fracture risk reduction. The novelty of this literature research: these insights showed once again that the patients with T2DM often have a lower TBS than those without diabetes or with normal glucose levels. Therefore, the decline in TBS may reflect an early stage of bone health impairment in T2DM. The novelty of the TBS as a handy, non-invasive method that proved to be an index of bone microarchitecture confirms its practicality as an easily applicable tool for assessing bone fragility in T2DM.

Trabecular Bone Score in Assessing Bone Mineralization Status in Children with End- Stage Renal Disease: A Promising Tool

Areal-bone mineral density (aBMD) of lumbar-spine dual energy X-ray absorptiometry (DXA) scan is the most frequently used tool in evaluating BMD in pediatric patients, however its size dependency have significant impact on measurements accuracy in children with chronic kidney disease (CKD). This study aimed to evaluate the usefulness of trabecular bone score (TBS) computed during lumbar-spine DXA scan in assessing bone status in children on maintenance hemodialysis (HD). Ninety-three children on HD (aged 9–18 years) were subjected to lumbar-spine DXA-scan to obtain aBMD (g/cm2) and TBS.Z-scores of aBMD for chronological-age (aBMDZ-CA), height-age (aBMDZ-HA), and TBSZ-score were calculated using mean and SD values of 442 healthy controls. aBMD and TBS were significantly lower in short-for-age and normal height-for-age patients compared to the corresponding values of controls (p < 0.05 for all). Degraded vertebral microarchitecture (TBSZ-score < -2) was detected in 48% and 44% of male and female patients respectively. There were no significant differences in median TBSZ-score between short-for-age and normal height-for-age HD patients in male (p = 0.425) and in female (p = 0.316) patients. TBSZ-score correlated significantly with aBMDZ-CA (r = 0.234; p = 0.024) but not with aBMDZ-HA (r = 0.077; p = 0.462). Patients with history of fractures (5 patients only) had significantly lower TBS scores compared to those without fracture history (p = 0.016).Conclusion: TBS is significantly reduced in children on maintenance HD and is associated with increased fracture incidence. TBS has shown to be a promising tool in assessing bone quality (trabecular microarchitecture) in children with CKD being not size-dependent as is a-BMD, for further evaluation of its potential role in therapeutic and follow-up decisions.What is Known:• In children with CKD, bone demineralization starts as early as CKD stage 2, so assessment of bone health is mandatory for follow up and therapeutic decisions.• aBMD of lumbar-spine DXA scan is the most used tool in evaluating BMD in pediatric patients, however its size dependency have significant impact on measurements made in children with CKD.What is New:• TBS is significantly reduced in children on maintenance HD and associated with increased fracture incidence.• TBS has shown to be a promising tool in assessing bone quality (trabecular microarchitecture) in children with CKD being not size-dependent as is a-BMD.

Evaluation of bone mineral density and trabecular bone score for diagnosis of osteoporosis in Iranian diabetic patients

Introduction: Type 2 diabetes mellitus (T2DM) increases the risk of bone fractures. Objectives: This study aimed to examine the use of trabecular bone score (TBS) and BMD to select the best diagnostic tool for osteoporosis caused by type 2 diabetes. Patients and Methods: One hundred and four patients (52 individuals with type 2 diabetes and 52 ones without diabetes) aged at most 50 years were enrolled in a cross-sectional study that was conducted with dual-energy X-ray absorptiometry (DXA) images of patients referred to Khorshid and Al-Zahra hospitals, Isfahan, Iran. Results: Lumbosacral bone mineral density (BMD) was significantly lower in the diabetic group than in the control group (0.76 versus 0.82, P=0.041). The mean lumbosacral TBS was significantly lower in the diabetic group than in the controls (1.24 versus 1.36, P=0.001). Therefore, the lumbosacral TBS provided a more reliable indicator than lumbosacral BMD to discriminate between controls and women with T2DM. Conclusion: The TBS is recommended for early diagnosis of osteoporosis in diabetic patients because of its independence from BMD-related parameters. The TBS can capture a larger portion of the bone deterioration in women with T2DM that cannot be detected using methods based solely on BMD.

Bone health evaluation in primary hyperparathyroidism using dual-energy X-ray absorptiometry and trabecular bone score.

Bone involvement in primary hyperparathyroidism (PHPT) is characterized by reduced bone mineral density (BMD) using dual X-ray absorptiometry (DXA). A hallmark of PHPT is BMD loss at cortical sites while trabecular bone remains relatively preserved. PHPT is associated with increased fracture risk at both trabecular and cortical skeletal sites, which cannot be explained based on BMD values alone. The application of the trabecular bone score (TBS), an index of the lumbar spine DXA bone microarchitecture, showed lower TBS values and increased risk of fractures in PHPT patients, independent of BMD. Although further prospective studies are needed, promising data have been published with the use of TBS and some advanced DXA-based imaging modalities in patients with PHPT.

Update on trabecular bone score.

Trabecular bone score (TBS) is an indirect and noninvasive measure of bone quality. A low TBS indicates degraded bone microarchitecture, predicts osteoporotic fracture, and is partially independent of clinical risk factors and bone mineral density (BMD). There is substantial evidence supporting the use of TBS to assess vertebral, hip, and major osteoporotic fracture risk in postmenopausal women, as well as to assess hip and major osteoporotic fracture risk in men aged > 50 years. TBS complements BMD information and can be used to adjust the FRAX (Fracture Risk Assessment) score to improve risk stratification. While TBS should not be used to monitor antiresorptive therapy, it may be potentially useful for monitoring anabolic therapy. There is also a growing body of evidence indicating that TBS is particularly useful as an adjunct to BMD for fracture risk assessment in conditions associated with increased fracture risk, such as type-2 diabetes, chronic corticosteroid excess, and other conditions wherein BMD readings are often misleading. The interference of abdominal soft tissue thickness (STT) on TBS should also be considered when interpreting these findings because image noise can impact TBS evaluation. A new TBS software version based on an algorithm that accounts for STT rather than BMI seems to correct this technical limitation and is under development. In this paper, we review the current state of TBS, its technical aspects, and its evolving role in the assessment and management of several clinical conditions.

Trabecular Bone Score as a Reliable Measure of Lumbar Spine Bone Microarchitecture in Acromegalic Patients.

Although GH and IGF-1 excess has a controversial impact on bone mineral density (BMD), acromegalic patients display variable degrees of bone structure impairment. In this study, we aim to investigate the usefulness of trabecular bone score (TBS), compared to BMD, in identifying acromegalic patients with impaired lumbar spine trabecular microarchitecture. Forty-four acromegalic patients were investigated for disease control, metabolic and gonadal status, bone metabolism parameters, and the presence of vertebral fractures (VFs). Patients and matched healthy controls underwent BMD and TBS examination. Mean TBS values were lower in patients than in controls (p &lt; 0.001), without significant differences in mean lumbar and femoral BMD. TBS values were significantly higher in controlled patients compared to the uncontrolled ones (p = 0.012). No significant differences were found in bone markers with respect to disease control. Mean TBS or lumbar BMD did not significantly differ in patients with or without VFs (prevalence 11.4%). TBS and BMD levels were lower in hypogonadal patients compared to the eugonadal ones (p = 0.030 and p &lt; 0.001, respectively). In conclusion, TBS values are significantly lower in patients than in controls, confirming the presence of impaired lumbar spine trabecular bone in acromegaly. Both uncontrolled disease and hypogonadism contribute to TBS deterioration in acromegaly.

Application and prospect of trabecular bone score in differentiated thyroid cancer patients receiving thyrotropin suppression therapy.

Thyroid-stimulating hormone (TSH) suppression therapy is one of the common treatments for most patients with differentiated thyroid cancer (DTC). Unfortunately, its detrimental effects on bone health are receiving increasing attention. It may increase the risk of osteoporosis and osteoporotic fractures. The trabecular bone score (TBS) is a relatively new gray-scale texture measurement parameter that reflects bone microarchitecture and bone strength and has been shown to independently predict fracture risk. We reviewed for the first time the scientific literature on the use of TBS in DTC patients on TSH suppression therapy and aim to analyze and compare the utility of TBS with bone mass strength (BMD) in the management of skeletal health and prediction of fracture risk. We screened a total of seven relevant publications, four of which were for postmenopausal female patients and three for all female patients. Overall, postmenopausal female patients with DTC had lower TBS and a significant reduction in TBS after receiving TSH suppression therapy, but their BMD did not appear to change significantly. In addition, TBS was also found to be an independent predictor of osteoporotic fracture risk in postmenopausal women with DTC receiving TSH suppression therapy. However, due to limitations in the number of studies and study populations, this evidence is not sufficient to fully demonstrate the adverse effects of TSH suppression therapy on patients’ TBS or BMD and the efficacy of TBS, and subsequent larger and more case-cohort studies are needed to further investigate the relationship and application of TBS to TSH suppression therapy in terms of skeletal health impairment and fracture risk in DTC patients.

The applicability of trabecular bone score for osteoporosis diagnosis in ankylosing spondylitis

Ankylosing spondylitis (AS) patients have a high risk of osteoporotic fractures. The aim of this study was to evaluate the usefulness of trabecular bone score (TBS) in assessing fracture risk in patients with AS. 67 patients meeting the ASAS classification criteria were enrolled in the study. Fracture risk for each patient was assessed based on a lumbar spine exam encompassing bone mineral density (BMD), and TBS through a dual-energy X-ray absorptiometry (DXA) exam. In addition, each patient had an X-ray taken of their lumbar and thoracic spine to determine the presence of syndesmophytes and bony bridges, as well as spinous process and vertebral body fractures. Moreover, each patient's medical history was analyzed for other osteoporotic fractures. A major osteoporosis fracture (MOF) was found in 11 (16%) patients in total, of which 7 (10%) were vertebral body fractures. The mean TBS in patients with MOF and no MOF were, respectively, 1.12 and 1.29 (p < 0.001). No significant differences were found in BMD scores between the two groups. Syndesmophytes and bony bridges occurred more frequently in patients with MOF (p = 0.02). Age of 50 or more (RR = 9.86, p = 0.002), TBS score ≤ 1.31 (RR = 2.07, p < 0.0001), and presence of syndesmophytes and bony bridges (RR = 2.14, p = 0.04) were considered a relative risk (RR) increasing factors. TBS is a markedly more sensitive method of identifying patients with a high fracture risk compared to BMD measurement in a DXA exam in patients with AS.

Trabecular Bone Score (TBS) in Patients with Early Ankylosing Spondylitis-Limited Utility.

Purpose: Ankylosing spondylitis (AS) not only results in pathological ossification of the spine, but can also be associated with osteoporosis. Due to the presence of syndesmophytes and possible involvement of the hip joints, classical dual X-ray absorptiometry (DXA) is of limited use in patients with advanced stages of AS. Trabecular bone score (TBS) is a method complementary to DXA, providing additional information about bone microarchitecture. There is a growing body of evidence for the usefulness of TBS in AS patients. The aim of this study was to assess the clinical utility of TBS in patients with AS. Methods: Patients with AS underwent DXA with additional TBS assessment. A cross-sectional analysis of the frequency of osteoporosis and bone microarchitecture deterioration and their association with patients’ characteristics was done. Results: A total of 51 male patients, mean age 40.7 years, were enrolled. Osteoporosis was diagnosed in seven patients (13.7%). Lumbar bone mineral density (BMD) was higher (p < 0.001) than femoral BMD, indicating abnormal BMD readings in the spine caused by syndesmophytes. Patients with DXA-diagnosed osteoporosis had lower TBS (p = 0.03) and TBS T-score (p = 0.043) values compared to patients without osteoporosis. However, disturbed bone microarchitecture (TBS < 1.23) was present in only three patients (5.9%). None of the patients had a history of an osteoporotic fracture. A lower TBS T-score (p = 0.032) was demonstrated in patients with sacroiliitis grade 4 than in patients with sacroiliitis grade 2, with no significant differences in BMD and T-score values. Conclusion: Among patients with early AS, the clinical utility of TBS is limited—it does not add value to DXA.

Age-Specific Normative Values of Lumbar Spine Trabecular Bone Score (TBS) in Taiwanese Men and Women

Trabecular bone score (TBS) is a novel method for assessing trabecular microarchitecture. Normative values of TBS are available for various populations of the world but are not yet available for Taiwanese adults. Therefore, the purpose of this study was to estimate age-specific, normative TBS curves for Taiwanese men and women. Medical records of general health examinations from a regional hospital in Southern Taiwan were reviewed. Individuals aged 30–90 years with data on lumbar spine bone mineral density (BMD) were included. TBS was retrospectively calculated from dual-energy X-ray absorptiometry scans using TBS iNsight software. Of the 12,028 patients included, 4533 (37.7%) were male and the mean age was 55.8 years. The mean TBS was 1.392 (standard deviation (SD) 0.089) for men and 1.344 (SD 0.107) for women. In women, TBS declined at a rate of 0.0004/year among those aged 30.0–45.9 years, 0.0106/year among those 46.0–60.7 years, and 0.0028/year among those 60.8–90.0 years. In men, TBS declined at a constant rate of 0.0023/year over the entire age range. In conclusion, age-adjusted, normative curves of TBS for Taiwanese men and women are presented, which could be used to facilitate the use of TBS in assessing bone status in clinical practice.

Application of the Trabecular Bone Score in Clinical Practice.

The trabecular bone score (TBS) was introduced as an indirect index of trabecular microarchitecture, complementary to bone mineral density (BMD), and is derived using the same dual energy X-ray absorptiometry images. Recently, it has been approved for clinical use in Korea. Therefore, we conducted a comprehensive review to optimize the use of TBS in clinical practice. The TBS is an independent predictor of osteoporotic fractures in postmenopausal women and men aged >50 years. The TBS is potentially useful in monitoring the skeletal effects of anabolic agents but not of antiresorptive agents. In postmenopausal women with type 2 diabetes mellitus, the TBS assesses osteoporotic fracture risk not captured by BMD. However, high body mass index and soft tissue thickness can cause underestimation of the TBS; however, this limitation has been improved in recent versions of the TBS software. However, a high precision error and low reproducibility limit the use of TBS. This review may provide information on the application of the TBS in clinical practice based on reliable evidence.

Bone Quality as Measured by Trabecular Bone Score in Normocalcemic Primary Hyperparathyroidism

ObjectiveThe impact of normocalcemic hyperparathyroidism (NHPT) on bone quality remains largely unexplored. We aimed to investigate the usefulness of trabecular bone score (TBS) assessment in NHPT and the accuracy of TBS in predicting vertebral fractures (VFs) in NHPT. MethodsIn this multicentric cross-sectional study, we assessed the TBS in 47 subjects with NHPT, 41 with primary hyperparathyroidism (PHPT), and 39 age- and sex-matched control subjects. ResultsTBS values did not differ among the 3 groups. The prevalence of low TBS (TBS < 1.2) was 23.4% in NHPT, 26.8% in PHPT, and 15.4% in controls, without statistically significant differences between groups. However, we found a lower lumbar spine Z-score adjusted for TBS (LS Z-score∗TBS) in PHPT participants when compared with controls (-0.48 ± 1.06 vs 0.07 ± 0.93, P = .017). In NHPT group, LS Z-score∗TBS did not detect patients with overall VFs (threshold, -0.15; area under the curve, 0.45; 95% CI, 0.253-0.648; accuracy, 55.3%). Instead, it was useful for moderate-severe VFs (threshold, 0.55; area under the curve, 0.81; 95% CI, 0.62-0.996; accuracy, 83%). In PHPT subjects also, TBS did not predict VFs. ConclusionIn NHPT, TBS is not reduced. When adjusted for TBS, the LS Z-score might predict moderate-to-severe VFs.

Trabecular bone score and bone mineral density in patients with long-term controlled acromegaly.

Acromegaly is associated with increased vertebral fracture (VFs) risk not correlated to bone mineral density (BMD). Trabecular bone score (TBS), related to bone microarchitecture, provides information on bone strength. This cross-sectional study considered the usefulness of TBS and BMD to assess bone status in long-term controlled acromegalic patients. 26 acromegaly patients (14 female and 12 males) were included in the study. A further 117 subjects were recruited as controls (58 females and 57 males). BMD was measured using dual-energy X-ray absorptiometry (DXA), TBS was obtained applying Medimaps software 2.0. Biochemical parameters were determined by standardized techniques. 73% of patients with acromegaly exhibited normal lumbar spine (LS) BMD. TBS was normal in 38% of acromegalic patients and partially degraded or degraded in 31% of patients, respectively. No differences were found in LS BMD between acromegalic patients and controls. TBS values were significantly lower in patients with acromegaly (1.27±0.13 vs. 1.35±0.17, p=.01). Postsurgical remission was associated with higher TBS values (1.35±0.10 vs. 1.23±0.13, p=.02) and pituitary radiotherapy treatment with lower TBS values (1.18±0.12 vs. 1.31±0.12, p=.004). On multivariate analysis, age, BMI and LS BMD were predictors of TBS changes in patients with acromegaly (p<.05). Patients with long-term controlled acromegaly can exhibit deterioration of bone microstructure measured with TBS, despite BMD measurement not showing bone loss. Our study suggests that TBS is useful for monitoring the bone status changes in acromegalic patients.

What Role Does Trabecular Bone Score Play in Chronic Inflammatory Rheumatic Diseases?

Patients suffering from rheumatic inflammatory diseases, e.g., systemic sclerosis, rheumatoid arthritis, and ankylosing spondylitis, are at risk of low bone mass. Dual-energy X-ray Absorptiometry (DXA) is the traditional radiological measurement technique for bone mineral density (BMD). The recently developed trabecular bone score (TBS) enhances the skeletal information provided by standard BMD. It re-analyzes the spatial dynamics of pixel intensity changes in lumbar spine DXA images, defining a quantitative index, characterizing trabecular bone microarchitecture. It has been demonstrated that low TBS values are associated with an increased incidence of fractures in patients with rheumatic diseases. These methods used together for bone damage evaluation can be of value to identify individuals who will potentially fracture. The main scientific literature on the clinical aspects of osteoporosis, including the use of TBS in evaluating this pathology, are herein reported aimed at shedding light on the role trabecular bone score plays in chronic inflammatory rheumatic diseases.

Performance of bone mineral density and trabecular bone score in assessment of bone quality in Egyptian male patients with ankylosing spondylitis

BackgroundOsteoporosis is a common complication of ankylosing spondylitis (AS) even in the early stages of disease; however, previously published studies have demonstrated large discrepancies in the reported incidence of osteoporosis, based on measurement of bone mineral density (BMD). The aim of the present study was to compare bone quality using trabecular bone score (TBS) between AS patients and healthy controls and to evaluate factors associated with TBS in patients with AS.ResultsAnkylosing spondylitis patients had significantly lower BMD and T score at the neck of femur and lower total hip BMD than controls (BMD p = 0.010 and 0.032 respectively), (T score p = 0.006 and p = 0.025 respectively). The mean TBS was significantly lower in AS patients than in controls (p < 0.001). Lumbar spine TBS was directly correlated with BMI (p = 0.029) and BMD at the neck of femur (p = 0.016) and BMD of total hip (p = 0.007) while inversely correlated with the Bath AS Metrology Index (BASMI) (p = 0.026), the modified Stoke AS Spinal Score (mSASS) (p = 0.029), ESR (p = 0.031), and CRP (p = 0.033).ConclusionTBS evaluation detected lower bone quality in the lumbar spine in patients with AS when compared with matched controls, while lumbar BMD failed to identify it. These findings encourage the use of TBS as a beneficial tool to recognize the risk of axial osteoporosis as early as possible in AS patients. Also, we recommend its use for regular follow up of drug treatment for those patients.

Diagnosis and treatment of osteoporosis in elderly patients with type 2 diabetes

Osteoporosis, falls and low-energy fractures have a high prevalence in elderly, which is increasing in the presence of diabetes mellitus type 2 (T2DM). Patients with T2DM have a low rate of bone metabolism, a pronounced change in bone microarchitecture. The use of trabecular bone score in evaluating of densitometry and the FRAX scale improves the sensitivity of the methods in patients with diabetes. Integrated approach is required in elderly patient with type 2 diabetes and includes assessment of geriatric status, diabetes status, correction of multiple complications of diabetes, carbohydrate metabolism, vitamin D deficiency, selection of the most effective hypoglycemic and anti-osteoporetic therapy and development of preventive and treatment methods aimed to reduce falls risk and fractures rate.