A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX

McCloskey, Eugene V.<sup>1</sup>; Odén, Anders<sup>1</sup>; Harvey, Nicholas C.<sup>2</sup>; Leslie, William D.<sup>3</sup>; Hans, Didier<sup>4</sup>; Johansson, Helena<sup>1</sup>; Barkmann, Reinhard<sup>5</sup>; Boutroy, Stephanie<sup>6</sup>; Brown, Jacques<sup>7</sup>; Chapurlat, Roland<sup>6</sup>; Elders, Petra J. M.<sup>8</sup>; Fujita, Yuki<sup>9</sup>; Glüer, Claus-C<sup>5</sup>; Goltzman, David<sup>10</sup>; Iki, Masayuki<sup>9</sup>; Karlsson, Magnus<sup>11</sup>; Kindmark, Andreas<sup>12</sup>; Kotowicz, Mark<sup>13</sup>; Kurumatani, Norio<sup>14</sup>; Kwok, Timothy<sup>15</sup>; Lamy, Oliver<sup>4</sup>; Leung, Jason<sup>15</sup>; Lippuner, Kurt<sup>16</sup>; Ljunggren, Östen<sup>12</sup>; Lorentzon, Mattias<sup>17,18</sup>; Mellström, Dan<sup>17,18</sup>; Merlijn, Thomas<sup>8</sup>; Oei, Ling<sup>13</sup>; Ohlsson, Claes<sup>18</sup>; Pasco, Julie A.<sup>13</sup>; Rivadeneira, Fernando<sup>19</sup>; Rosengren, Björn<sup>11</sup>; Sornay-Rendu, Elisabeth<sup>6</sup>; Szulc, Pawel<sup>6</sup>; Tamaki, Junko<sup>20</sup>; Kanis, John A.<sup>1</sup>

Affiliations

¹Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

²MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

³University of Manitoba, Winnipeg, Canada

⁴Lausanne University Hospital, Center of Bone Diseases, Lausanne, Switzerland

⁵Sektion Biomedizinische Bildgebung Klinik für Diagnostische Radiologie, Kiel, Germany

⁶INSERM UMR 1033 and Lyon University, E Herriot Hospital (HEH), Lyon, France

⁷Department of Rheumatology, Laval University, Quebec, Canada

⁸Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands

⁹Department of Public Health, Kinki University Faculty of Medicine, Osaka, Japan

¹⁰Department of Medicine, McGill University Health Centre and McGill University, Montreal, Canada

¹¹Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Malmö, and Department of Orthopaedics, Skåne University Hospital, Malmo, Sweden

¹²Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden

¹³Epi-Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia

¹⁴Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara, Japan

¹⁵Jockey Club Centre for Osteoporosis Care and Control, the Chinese University of Hong Kong, Hong-Kong, China

¹⁶Department of Osteoporosis, Inselspital, Berne University Hospital, Bern, Switzerland

¹⁷Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenberg, Sweden

¹⁸Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

¹⁹Department of Internal Medicine and Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands

²⁰Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan

Abstract and keywords

Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35–1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24–1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65–1.87 versus 1.70, 95% CI 1.60–1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines.

Keywords: TRABECULAR BONE STRUCTURE; TBS; FRACTURE; RISK; FRAX; META-ANALYSIS

Links

DOI: 10.1002/jbmr.2734

PubMed: 26498132

WoS: 000377270400004

History

Received: 2015-02-26

Revised: 2015-10-08

Accepted: 2015-10-23

Online: 2015-10-24

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