Journal of Bone and Mineral Research (2011)
Bone micro-architecture assessed by TBS predicts osteoporotic fractures independent of bone density: The Manitoba study
Didier Hans, Andrew L. Goertzen, Marc‐Antoine Krieg, William D. Leslie
Abstract
The measurement of BMD by DXA is the gold standard for diagnosing osteoporosis, but does not directly reflect deterioration in bone micro‐architecture. The trabecular bone score (TBS), a novel grey‐level texture measurement that can be extracted from DXA images, correlates with 3D parameters of bone micro‐architecture. Our aim was to evaluate the ability of lumbar spine TBS to predict future clinical osteoporotic fractures.
29,407 women ≥ 50 years at the time of baseline hip and spine DXA were identified from a database containing all clinical results for the Province of Manitoba, Canada. Health service records were assessed for the incidence of non‐traumatic osteoporotic fracture codes subsequent to BMD testing (mean follow‐up 4.7 years). Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes.
Osteoporotic fractures were identified in 1,668 (5.7%) women including 439 (1.5%) spine and 293 (1.0%) hip fractures. Significantly lower spine TBS and BMD were identified in women with major osteoporotic, spine and hip fractures (all p < .0001). Spine TBS and BMD predicted fractures equally well, and the combination was superior to either measurement alone (p < 0.001).
Spine TBS predicts osteoporotic fractures and provides information that is independent of spine and hip BMD. Combining the TBS trabecular texture index with BMD incrementally improves fracture prediction in postmenopausal women.
© 2011 American Society for Bone and Mineral Research