Trabecular bone score reference values for children and adolescents according to age, sex, and ancestry

Kalkwarf, Heidi J.; Shepherd, John A.; Hans, Didier; Rodriguez, Elena Gonzalez; Kindler, Joseph M.; Lappe, Joan M.; Oberfield, Sharon; Winer, Karen K.; Zemel, Babette S.

Affiliations

¹Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, USA

²Cancer Center, University of Hawaii, Honolulu, HI, USA

³Interdisciplinary Center for Bone Diseases, Bone and Joint Department, Lausanne University and Lausanne University Hospital, Lausanne, Switzerland

⁴Department of Nutritional Sciences, University of Georgia, Athens, GA, USA

⁵Department of Medicine, Creighton University, Omaha, NE, USA

⁶Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA

⁷Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

⁸Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

Abstract and keywords

Trabecular bone score (TBS) is used for fracture prediction in adults, but its utility in children is limited by absence of appropriate reference values. We aimed to develop reference ranges for TBS by age, sex, and population ancestry for youth ages 5 to 20 years. We also investigated the association between height, body mass index (BMI), and TBS, agreement between TBS and lumbar spine areal bone mineral density (aBMD) and bone mineral apparent density (BMAD) Z-scores, tracking of TBS Z-scores over time, and precision of TBS measurements. We performed secondary analysis of spine dual-energy X-ray absorptiometry (DXA) scans from the Bone Mineral Density in Childhood Study (BMDCS), a mixed longitudinal cohort of healthy children (n = 2014) evaluated at five US centers. TBS was derived using a dedicated TBS algorithm accounting for tissue thickness rather than BMI. TBS increased only during ages corresponding to pubertal development with an earlier increase in females than males. There were no differences in TBS between African Americans and non-African Americans. We provide sex-specific TBS reference ranges and LMS values for calculation of TBS Z-scores by age and means and SD for calculation of Z-scores by pubertal stage. TBS Z-scores were positively associated with height Z-scores at some ages. TBS Z-scores explained only 27% and 17% of the variance of spine aBMD and BMAD Z-scores. Tracking of TBS Z-scores over 6 years was lower (r = 0.47) than for aBMD or BMAD Z-scores (r = 0.74 to 0.79), and precision error of TBS (2.87%) was greater than for aBMD (0.85%) and BMAD (1.22%). In sum, TBS Z-scores provide information distinct from spine aBMD and BMAD Z-scores. Our robust reference ranges for TBS in a well-characterized pediatric cohort and precision error estimates provide essential tools for clinical assessment using TBS and determination of its value in predicting bone fragility in childhood and adolescence.

Keywords: DXA; PEDIATRIC; TRABECULAR BONE SCORE; BONE MINERAL DENSITY; LUMBAR SPINE

Links

DOI: 10.1002/jbmr.4520

PubMed: 35080046

WoS: 000756077700001

History

Received: 2021-10-22

Revised: 2022-01-18

Accepted: 2022-01-25

Cited Works (3)

Year	Entry
2014	Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP. Trabecular bone score: a noninvasive analytical method based upon the dxa image. J Bone Miner Res. March 2014;29(3):518-530.
2011	Zemel BS, Kalkwarf HJ, Gilsanz V, Lappe JM, Oberfield S, Shepherd JA, Frederick MM, Huang X, Lu M, Mahboubi S, Hangartner T, Winer KK. Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children: results of the bone mineral density in childhood study. J Clin Endocrinol Metab. October 2011;96(10):3160-3169.
2020	Rehberg M, Azim M, Martakis K, Winzenrieth R, Hoyer‐Kuhn H, Schoenau E, Semler O, Duran I. Bone microarchitecture assessed by trabecular bone score is independent of mobility level or height in pediatric patients with cerebral palsy. J Bone Miner Res. September 2020;35(9):1685-1694.

Cited By (1)

Year	Entry
2023	Valenzuela Riveros LF, Long J, Bachrach LK, Leonard MB, Kent K. Trabecular bone score (TBS) varies with correction for tissue thickness versus body mass index: implications when using pediatric reference norms. J Bone Miner Res. April 2023;38(4):493-498.