Premenopausal and early postmenopausal trabecular bone score (TBS) and fracture risk:​ Study of Women's Health Across the Nation (SWAN)

Greendale, Gail A.; Huang, MeiHua; Cauley, Jane A.; Harlow, Sioban; Finkelstein, Joel S.; Karlamangla, Arun S.

Affiliations

¹Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States of America

²Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, Crabtree Hall A547, 130 DeSoto Street, Pittsburgh, PA, 15261, United States of America

³Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 1415 Washington Heights, Room 6618, Ann Arbor, MI 48109, United States of America

⁴Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, 50 Blossom St, Boston, MA 02114, United States of America

Abstract and keywords

Background: Evidence that trabecular bone score (TBS), an index of bone microstructure, is a risk factor for future fracture comes mainly from studies of late postmenopausal women.

Objective: To discern whether premenopausal TBS or early postmenopausal TBS predict fracture.

Design: A 22-year, prospective analysis from the Study of Women's Health Across Nation.

Setting: Community-based cohort.

Participants: 272 Black, 174 Japanese, and 364 White women.

Main outcome measures: Incident fractures: 292 in premenopausal sample and 141 in early postmenopausal sample.

Results: Separate Cox proportional hazard regressions modeled time to incident fracture as a function of TBS measured during premenopause or early postmenopause. Models were initially adjusted for age, race/ethnicity, SWAN clinical site, body mass index, use of calcium, vitamin D, bone beneficial or bone adverse medication. Next, we added lumbar spine (LS) or femoral neck (FN) bone mineral density (BMD) and, finally, history of prior fracture, to the models. For each standard deviation decrement in premenopausal TBS, fracture hazard was elevated by 17% (relative hazard [RH] 1.17 [95% CI, 1.02–1.35]); after adjusting for LS or FN BMD, the relation between premenopausal TBS and fracture was no longer statistically significant. There was a similar-magnitude, marginally statistically significant, association between early postmenopausal TBS and fracture, unadjusted for BMD (RH 1.15 [0.95–1.39]).

Conclusions: Variation in premenopausal TBS is related to fracture risk, but this association is not independent of BMD.

Keywords: Menopause; Trabecular bone score; Epidemiology; Cohort; Longitudinal

Links

DOI: 10.1016/j.bone.2020.115543

PubMed: 32730933

WoS: 000572849900009

History

Received: 2020-04-22

Revised: 2020-07-20

Accepted: 2020-07-20

Online: 2020-07-27

Cited Works (7)

Year	Entry
2014	Iki M, Tamaki J, Kadowaki E, Sato Y, Dongmei N, Winzenrieth R, Kagamimori S, Kagawa Y, Yoneshima H. Trabecular bone score (TBS) predicts vertebral fractures in Japanese women over 10 years independently of bone density and prevalent vertebral deformity: the Japanese population-based osteoporosis (JPOS) cohort study. J Bone Miner Res. February 2014;29(2):399-407.
2020	Leslie WD, Schousboe JT, Morin SN, Martineau P, Lix LM, Johansson H, McCloskey EV, Harvey NC, Kanis JA. Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study. Osteoporos Int. June 2020;31(6):1059-1067.
2000	Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. April 2000;15(4):721-739.
2000	Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Marcus R, Matkovic V, Weaver C. Peak bone mass. Osteoporos Int. December 2000;11(12):985-1009.
2020	Cummings SR, Eastell R. Stop (mis)classifying fractures as high- or low-trauma or as fragility fractures. Osteoporos Int. June 2020;31(6):1023-1024.
2016	Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O’Karma M, Wallace TC, Zemel BS. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. April 2016;27(4):1281-1386.
2011	Hans D, Goertzen AL, Krieg M-A, Leslie WD. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res. November 2011;26(11):2762-2769.