Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: the Eastern European TBS study

J. Vasic, T. Petranova, V. Povoroznyuk, C.G. Barbu, M. Karadzic, F. Gojkovic, J. Elez, R. Winzenrieth, D. Hans, V. Culafic Vojinovic, C. Poiana, N. Dzerovych, R. Rashkov, A. Dimic

Abstract


The aim of the study was to assess the cli­nical performance of the model combining areal bone mineral density (aBMD) at spine and microarchitecural texture (TBS) for the detection of the osteoporo­tic fracture. The Eastern European Study is a multicenter study (Serbia, Bulgaria, Romania and Ukraine) evaluating the role of TBS in routine clinical practice as a complement to aBMD. All scans were acquired on Holo­gic Disco­very and GE Prodigy densitometers in a routine clinical manner. The additional clinical values of aBMD and TBS were analyzed using a two steps classification tree approach (aBMD followed by TBS tertiles) for all type of osteoporotic fracture (All-OP Fx). Sensitivity, specifi­city and accuracy of fracture detection as well as the Net Reclassification Index (NRI) were calculated. This study involves 1031 women subjects aged 45 and older recrui­ted in east European countries. Clinical centers were cross-calibrated in terms of BMD and TBS. As expe­cted, areal BMD (aBMD) at spine and TBS were only mo­derately correlated (r2 = 0.19). Prevalence rate for All-OP Fx was 26%. Subjects with fracture have significant lower TBS and aBMD than subjects without fracture (p < 0.01). TBS remains associated with the fracture even after adjustment for age and aBMD with an OR of 1.27 [1.07–1.51]. When using aBMD T-score of –2.5 and the lowest TBS tertile thre­sholds, both BMD and TBS were similar in terms of sensitivity (35 vs. 39%), specificity (78 vs. 80%) and accuracy (64 vs. 66%). aBMD and TBS combination, induced a significant improvement in sensitivity (+28%) and accuracy (+17%) compared to aBMD alone whereas a moderate improvement was observed in terms of specificity (+9%). The overall combination gain was 36% as expressed using the NRI. aBMD and TBS combination decrease significantly the number of subjects needed to diagnose from 7 for aBMD alone to 2. In a multicentre Eastern European cohort, we have shown that the use of TBS in addition to the aBMD permit to reclassified correctly more than one-third of the overall subjects. Furthermore, the number of subjects needed to diagnose fell to 2 subjects. Economical stu­dies have to be performed to evaluate the gain induced by the use of TBS for the healthcare system.


Keywords


Osteoporotic fracture; Bone mineral density; Trabecular bone score (TBS); Bone microarchitecture

References


WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis [Report of the WHO Study Group] // World Health Organ Tech. Rep. Ser. 1994: 843-1129.

Johnell O., Kanis J.A., Oden E., Johansson H., De Laet C., Delmas P., Eisman J.A., Fujiwara S., Kroger H., Mellstrom D., Meunier P.J., Melton L.J. 3, O’Neill T., Pols H., Reeve J., Silman A., Tenenhouse A. Predictive value of BMD for hip and other fractures // J. Bone Miner. Res 2005; 20: 1185-1194.

Rice J.C., Cowin S.C., Bowman J.A. On the dependence of the elasticity and strength of cancellous bone on apparent density // J. Biomech. 1988; 21: 155-168.

Hordon L.D., Raisi M., Paxton S., Beneton M.M., Kanis J.A., Aaron J.E. Trabecular architecture in women and men of similar bone mass with and without vertebral fracture: part I. 2-D histology // Bone. 2000; 27: 271-276.

McClung M.R. Do current management strategies and guidelines adequately address fracture risk? // Bone. 2006; 38: S13-S17.

Compston J. Monitoring osteoporosis treatment // Best Pract. Res Clin. Rheumatol. 2009; 23:781-788.

Seeman E., Delmas P.D. Bone quality — the material and structural basis of bone strength and fragility // N. Engl. J. Med. 2006; 354: 2250-2261.

Ito M., Ikeda K., Nishiguchi M., Shindo H., Uetani M., Hosoi T., Orimo H. Multi-detector row CT imaging of vertebral microstructure for evaluation of fracture risk // J. Bone Miner. Res 2005; 20: 1828-1836.

Hans D., Barthe N., Boutroy S., Pothuaud L., Winzenrieth R., Krieg M.A. Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae // J. Clin. Densitom. 2011; 14: 302-312.

Winzenrieth R., Michelet F., Hans D. 3D microarchitecture correlations with 2D projection image grey level variations assessed by TBS using high Resolution CT acquisitions: effects of resolution and noise // J. Clin. Densitom. 2012 (Epub ahead of print).

Resch H., Trubrich A., Muschitz C., Kocijan R., Bittighofer C., Pirker T., Hans D. The impact of TBS in the analysis of gender specific differences in bone microarchitecture in females and males with fragility fractures // ASBMR annual meeting 2012 (S434).

Roux J.P., Wegrzyn J., Boutroy S., Bouxsein M.L., Hans D., Chapurlat R. The predictive value of trabecular bone score (TBS) on whole lumbar vertebrae mechanics: an ex vivo study // Osteoporos Int. 2013 (Epub ahead of print).

Winzenrieth R., Dufour R., Pothuaud L., Hans D. A retrospective case-control study assessing the role of trabecular bone score in postmenopausal Caucasian women with osteopenia: analyzing the odds of vertebral fracture // Calcif. Tissue Int. 2010; 86: 104-109.

Winzenrieth R., Cormier C., Del Rio L., Di Gregorio S. Is bone micro-architecture status at spine assessed by TBS related to femoral neck fracture? A Spanish case-control study // Osteoporos Int. 2013; 24: 991-998.

Lamy O., Metzger M., Krieg M.A., Aubry-Rozier B., Stoll D., Hans D. OsteoLaus: prediction of osteoporotic fractures by clinical risk factors and DXA, IVA and TBS // Rev. Med. Suisse. 2011; 7: 2130-2136.

Krueger D., Fidler E., Libber J., Aubry-Rosier B., Hans D., Binkley N. Spine trabecular bone score (TBS) subsequent to BMD improves vertebral and OP fracture discrimination in women // J. Clin. Densitom. 2012 (accep­ted).

Leib E., Lamy O., Winzenrieth R., Hans D. Assessment of women microarchitecture with and without osteoporotic fracture by TBS on white non Hispanic US women // 19th Annual ISCD meeting, Tampa, USA, 2013.

Hans D., Goertzen A., Krieg M.A., Leslie W. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study // J. Bone. Miner. Res. 2011; 26: 2762-2769.

Boutroy S., Hans D., Sornay-Rendu E., Vilayphiou N. et al. Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study // Osteoporos Int. 2013; 24: 77-85.

Popp A.W., Meer S., Krieg M.A., Perrelet R., Hans D., Lippuner K. Bone mineral density (BMD) combined with microarchitecture parameters (TBS) significantly improves the identification of women at high risk of fracture: the SEMOF cohort study // ECCEO-IOF joint meeting, Bordeaux, France, 2012.

Fan B., Lu Y., Genant H., Fuerst T., Shepherd J. Does standardized BMD still remove differences between Holo­gic and GE-Lunar state-of-the-art DXA systems? // Osteoporos Int. 2010; 21: 1227-1236.

Pencina M.J., D’Agostino R.B. Sr, D’Agostino R.B. Jr, Vasan R.S. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond // Stat. Med. 2008; 27: 157-172.

Youden W.J. An index for rating diagnostic tests // Cancer. 1950; 3: 32-35.

Breban S., Briot K., Kolta S., Paternotte S., Ghazi M., Fechtenbaum J., Roux C. Identification of rheumatoid arthritis patients with vertebral fractures using bone mineral density and trabecular bone score // J. Clin. Densitom. 2012; 201215: 260-266.

Romagnoli E., Cipriani C., Nofroni I., Castro C., Angelozzi M., Scarpiello A., Pepe J., Diacinti D., Piemonte S., Carnevale V., Minisola S. «Trabecular Bone Score» (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism // Bone. 2013; 53: 154-159.

Eller-Vainicher C., Morelli V., Ulivieri F.M., Palmieri S., Zhu­kouskaya V.V., Cairoli E., Pino R., Naccarato A., Scillitani A., Beck-Peccoz P., Chiodini I. Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism // J. Bone Miner. Res. 2012; 27: 2223-2230.

Paggiosi M., Eastell R. The impact of glucocorticoid therapy on trabecular bone score in older women // ASBMR annual meeting, Minneapolis, USA, 2012.




DOI: https://doi.org/10.22141/2224-1507.3.15.2014.79938

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