Abstract
Summary
It has been established that degenerative-changes at the spine elevate bone mineral density at the lumbar spine. This study in men reports that trabecular bone score may be less affected by spinal degenerative-changes.
Purpose
A recent tool for assessing trabecular microarchitecture at the lumbar spine, trabecular bone score (TBS), provides information about bone health complementary to lumbar spine areal BMD (here referred to as BMD). In men, mean BMD increases with increasing age due to degenerative-changes at the spine including osteophytes and aortic calcification. The aim of this study was to investigate whether TBS is similarly affected by the presence of degenerative-changes in men.
Methods
This study included 728 men aged 40–90 years enrolled in the Geelong Osteoporosis Study. Lumbar spine DXA scans (Lunar Prodigy) were used to determine TBS retrospectively (TBS iNsight software, Version 2.2), and for identification of degenerative-changes. Using multivariable regression techniques, the relationships between TBS or BMD and degenerative-changes were assessed, further adjusting for age and weight. The difference between each of the two methods was examined through testing interactions between method, degenerative-changes and age.
Results
Of 728 men, 439 (60.3%) were identified as having one or more degenerative-changes at the lumbar spine. Adjusted mean TBS was 1.219 (1.203–1.232) and 1.196 (1.179–1.212) for those with and without degenerative-changes, respectively. Adjusted mean BMD was 1.317 g/cm2 (1.297–1.336) and 1.198 g/cm2 (1.173–1.223) for those with and without degenerative-changes, respectively. Partial r2 for degenerative-changes in the model for TBS was 0.076 and for BMD, 0.257 (both p < 0.05). The three-way interaction between method, degenerative-changes and age was significant (p = 0.05) indicating significant effect of artefacts on the standardised values, affected by age and method.
Conclusion
This study suggests that TBS is less affected by degenerative-changes at the spine than is BMD. Thus, TBS may prove useful in the assessment of fracture risk in men with degenerative-changes at the spine.
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References
World Health Organisation (2007) WHO scientific group on the assessment of osteoporosis at primary health care level. Switzerland, Geneva
Czerwinski E, Badurski JE, Marcinowska-Suchowierska E, Osieleniec J (2007) Current understanding of osteoporosis according to the position of the World Health Organisation (WHO) and International Osteoporosis Foundation. Ortop Traumatol Rehabil 9:337–356
Pothuaud L, Barthe N, Krieg MA, Mehsen N, Carceller P, Hans D (2009) Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: a preliminary spine BMD-matched, case-control study. J Clin Densitom 12:170–176. https://doi.org/10.1016/j.jocd.2008.11.006
Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA (2006) The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int 17:1404–1409. https://doi.org/10.1007/s00198-006-0135-9
Pasco J, Lane S, Brennan S et al (2014) Fracture risk among older men: osteopenia and osteoporosis defined using cut-points derived from female versus male reference data. Osteoporos Int 25:857–862. https://doi.org/10.1007/s00198-013-2561-9
Henry MJ, Pasco JA, Korn S, Gibson JE, Kotowicz MA, Nicholson GC (2010) Bone mineral density reference ranges for Australian men: Geelong osteoporosis study. Osteoporos Int 21:909–917. https://doi.org/10.1007/s00198-009-1042-7
Seeman E (2008) Bone quality: the material and structural basis of bone strength. J Bone Miner Metab 26:1–8. https://doi.org/10.1007/s00774-007-0793-5
Pothuaud L, Carceller P, Hans D (2008) Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture. Bone 42:775–787. https://doi.org/10.1016/j.bone.2007.11.018
Schousboe JT, Vo T, Taylor BC, Cawthon PM, Schwartz AV, Bauer DC, Orwoll ES, Lane NE, Barrett-Connor E, Ensrud KE, for the Osteoporotic Fractures in Men (MrOS) Study Research Group (2016) Prediction of incident major osteoporotic and hip fractures by trabecular bone score (TBS) and prevalent radiographic vertebral fracture in older men. J Bone Miner Res 31:690–697. https://doi.org/10.1002/jbmr.2713
Hans D, Goertzen AL, Krieg MA, Leslie WD (2011) Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res 26:2762–2769. https://doi.org/10.1002/jbmr.499
Leslie WD, Aubry-Rozier B, Lix LM, Morin SN, Majumdar SR, Hans D (2014) Spine bone texture assessed by trabecular bone score (TBS) predicts osteoporotic fractures in men: the Manitoba Bone Density Program. Bone 67:10–14. https://doi.org/10.1016/j.bone.2014.06.034
Padlina I, Gonzalez-Rodriguez E, Hans D, Metzger M, Stoll D, Aubry-Rozier B, Lamy O (2016) The lumbar spine age-related degenerative disease influences the BMD not the TBS: the Osteolaus cohort. Osteoporos Int 28:909–915. https://doi.org/10.1007/s00198-016-3829-7
Kolta S, Briot K, Fechtenbaum J, Paternotte S, Armbrecht G, Felsenberg D, Glüer CC, Eastell R, Roux C (2014) TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int 25:1759–1764. https://doi.org/10.1007/s00198-014-2685-6
Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC (1997) Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int 7:564–569
Pasco JA, Nicholson GC, Kotowicz MA (2012) Cohort profile: Geelong osteoporosis study. Int J Epidemiol 41:1565–1575. https://doi.org/10.1093/ije/dyr148
Briot K, Paternotte S, Kolta S, Eastell R, Reid DM, Felsenberg D, Glüer CC, Roux C (2013) Added value of trabecular bone score to bone mineral density for prediction of osteoporotic fractures in postmenopausal women: the OPUS study. Bone 57:232–236. https://doi.org/10.1016/j.bone.2013.07.040
McCloskey EV, Odén A, Harvey NC, Leslie WD, Hans D, Johansson H, Barkmann R, Boutroy S, Brown J, Chapurlat R, Elders PJM, Fujita Y, Glüer CC, Goltzman D, Iki M, Karlsson M, Kindmark A, Kotowicz M, Kurumatani N, Kwok T, Lamy O, Leung J, Lippuner K, Ljunggren Ö, Lorentzon M, Mellström D, Merlijn T, Oei L, Ohlsson C, Pasco JA, Rivadeneira F, Rosengren B, Sornay-Rendu E, Szulc P, Tamaki J, Kanis JA (2016) A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res 31:940–948. https://doi.org/10.1002/jbmr.2734
Funding
This study is supported by the National Health and Medical Research Council (NHMRC) of Australia (251638, 299831, 628582), the Geelong Regional Medical Foundation, Arthritis Foundation of Australia, and Perpetual Trustees. KLH-K is supported by an Alfred Deakin Postdoctoral Research Fellowship.
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All participants provided written, informed consent. The study was approved by the Barwon Health Human Research Ethics Committee.
Conflict of interest
DH is co-owner of the TBS patent and has corresponding ownerships shares and position at Medimaps group. KBA, KLH-K, MM, MAK and JAP have no conflicts of interest to declare.
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Anderson, K.B., Holloway-Kew, K.L., Mohebbi, M. et al. Is trabecular bone score less affected by degenerative-changes at the spine than lumbar spine BMD?. Arch Osteoporos 13, 127 (2018). https://doi.org/10.1007/s11657-018-0544-3
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DOI: https://doi.org/10.1007/s11657-018-0544-3