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

wbldb

Iki, Masayuki¹; Tamaki, Junko¹; Kadowaki, Eiko¹; Sato, Yuho²; Dongmei, Namiraa¹; Winzenrieth, Renaud³; Kagamimori, Sadanobu⁴; Kagawa, Yoshiko⁵; Yoneshima, Hideo⁶

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

©2014 American Society for Bone and Mineral Research

Affiliations

¹Department of Public Health, Kinki University Faculty of Medicine, Osaka‐Sayama, Japan

²Department of Human Life, Jin‐ai University, Echizen, Japan

³Med‐Imaps, Hôpital Xavier Arnozan, Pessac, France

⁴University of Toyama, Toyama, Japan

⁵Kagawa Nutrition University, Sakado, Japan

⁶Shuwa General Hospital, Kasukabe, Japan
Abstract and keywords

Bone strength is predominantly determined by bone density, but bone microarchitecture also plays an important role. We examined whether trabecular bone score (TBS) predicts the risk of vertebral fractures in a Japanese female cohort. Of 1950 randomly selected women aged 15 to 79 years, we analyzed data from 665 women aged 50 years and older, who completed the baseline study and at least one follow-up survey over 10 years, and who had no conditions affecting bone metabolism. Each survey included spinal imaging by dual-energy X-ray absorptiometry (DXA) for vertebral fracture assessment and spine areal bone mineral density (aBMD) measurement. TBS was obtained from spine DXA scans archived in the baseline study. Incident vertebral fracture was determined when vertebral height was reduced by 20% or more and satisfied McCloskey-Kanis criteria or Genant's grade 2 fracture at follow-up. Among eligible women (mean age 64.1 ± 8.1 years), 92 suffered incident vertebral fractures (16.7/10³ person-years). These women were older with lower aBMD and TBS values relative to those without fractures. The unadjusted odds ratio of vertebral fractures for one standard deviation decrease in TBS was 1.98 (95% confidence interval [CI] 1.56, 2.51) and remained significant (1.64, 95% CI 1.25, 2.15) after adjusting for aBMD. The area under the receiver operating characteristic curve of TBS and aBMD combined was 0.700 for vertebral fracture prediction and was not significantly greater than that of aBMD alone (0.673). However, reclassification improvement measures indicated that TBS and aBMD combined significantly improved risk prediction accuracy compared with aBMD alone. Further inclusion of age and prevalent vertebral deformity in the model improved vertebral fracture prediction, and TBS remained significant in the model. Thus, lower TBS was associated with higher risk of vertebral fracture over 10 years independently of aBMD and clinical risk factors including prevalent vertebral deformity. TBS could effectively improve fracture risk assessment in clinical settings.

Keywords: DXA; OSTEOPOROSIS; FRACTURE RISK ASSESSMENT; GENERAL POPULATION STUDIES
Links

DOI: 10.1002/jbmr.2048

PubMed: 23873699

WoS: 000329773500014
History

Received: 2013-03-15

Revised: 2013-06-26

Accepted: 2013-07-11

Online: 2013-07-22

Cited Works (13)

Year	Entry
1994	Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. August 1994;9(8):1137-1141.
2003	Ammann P, Rizzoli R. Bone strength and its determinants. Osteoporos Int. March 2003;14(suppl 3):S13-S18.
2011	Vasikaran S, Eastell R, Bruyère O, Foldes AJ, Garnero P, Griesmacher A, McClung M, Morris HA, Silverman S, Trenti T, Wahl DA, Cooper C, Kanis JA; OF-IFCC Bone Marker Standards Working Group. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int. February 2011;22(2):391-420.
1993	Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. September 1993;8(9):1137-1148.
2002	Cummings SR, Melton LJ III. Epidemiology and outcomes of osteoporotic fractures. Lancet. May 18, 2002;359(9319):1761-1767.
2011	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. July 1, 2011;14(3):302-312.
1999	Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR; Study of Osteoporotic Fractures Research Group. Vertebral fractures and mortality in older women: a prospective study. Arch Intern Med. June 14, 1999;159(11):1215-1220.
1988	DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. September 1988;44(3):837-845.
2005	Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A. Predictive value of BMD for hip and other fractures. J Bone Miner Res. July 2005;20(7):1185-1194.
1991	Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. June 1, 1991;114(11):919-923.
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.
2006	Sambrook P, Cooper C. Osteoporosis. Lancet. June 17, 2006;367(9527):2010-2018.
2000	Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporos Int. August 2000;11(7):556-561.

Cited By (14)

Year	Entry
2019	Torres GHF, Guzman LFE, Alvarenga JC, Lopes NHM, Pereira RMR. Association of moderate/severe vertebral fractures with reduced trabecular volumetric bone density in older women and reduced areal femoral neck bone density in older men from the community: a cross-sectional study (SPAH). Maturitas. February 2019;120:61-67.
2020	Holloway-Kew KL, Rufus-Membere P, Anderson KB, Betson A, Gaston J, Kotowicz MA, Diez-Perez A, Hyde NK, Pasco JA. Bone material strength index is associated with prior fracture in men with and without moderate chronic kidney disease. Bone. April 2020;133:115241.
2020	Greendale GA, Huang M, Cauley JA, Harlow S, Finkelstein JS, Karlamangla AS. Premenopausal and early postmenopausal trabecular bone score (TBS) and fracture risk: Study of Women's Health Across the Nation (SWAN). Bone. November 2020;140:115543.
2021	Yokomoto-Umakoshi M, Umakoshi H, Sakamoto R, Fukumoto T, Ogata M, Nakano Y, Iwahashi N, Kaneko H, Mizoguchi N, Hattori A, Miyazawa T, Matsuda Y, Kawate H, Ogawa Y; Q-AND-A study group. Role of deteriorated bone quality in the development of osteoporosis in pheochromocytoma and paraganglioma. Bone. January 2021;142:115607.
2016	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 C-C, 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. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res. May 2016;31(5):940-948.
2020	Li G, Leslie WD, Kovacs CS, Prior J, Josse RG, Towheed T, Davison KS, Thabane L, Papaioannou A, Levine MAH, Goltzman D, Zeng J, Qi Y, Tian J, Adachi JD; Canadian Multicentre Osteoporosis Study (CaMos) Research Group. Combining frailty and trabecular bone score did not improve predictive accuracy in risk of major osteoporotic fractures. J Bone Miner Res. June 2020;35(6):1058-1064.
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.
2015	Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD. Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 2: trabecular bone score. J Clin Densitom. July–September 2015;18(3):309-330.
2020	Löffler MT, Sollmann N, Mei K, Valentinitsch A, Noël PB, Kirschke JS, Baum T. X-ray-based quantitative osteoporosis imaging at the spine. Osteoporos Int. February 2020;31(2):233-250.
2020	Borgen TT, Bjørnerem Å, Solberg LB, Andreasen C, Brunborg C, Stenbro M-B, Hübschle LM, Figved W, Apalset EM, Gjertsen J-E, Basso T, Lund I, Hansen AK, Stutzer J-M, Dahl C, Nordsletten L, Frihagen F, Eriksen EF. Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT. Osteoporos Int. March 2020;31(3):505-514.
2020	Paggiosi MA, Debono M, Walsh JS, Peel NFA, Eastell R. Quantitative computed tomography discriminates between postmenopausal women with low spine bone mineral density with vertebral fractures and those with low spine bone mineral density only: the SHATTER study. Osteoporos Int. April 2020;31(4):667-675.
2020	Bagherzadeh M, Sajjadi-Jazi SM, Sharifi F, Ebrahimpur M, Amininezhad F, Ostovar A, Shafiee G, Heshmat R, Mehrdad N, Razi F, Nabipour I, Larijani B. Effects of metabolic syndrome on bone health in older adults: the Bushehr Elderly Health (BEH) program. Osteoporos Int. October 2020;31(10):1975-1984.
2016	Oei L. Epidemiological, Radiological and Genetic Aspects of Endocrine Bone Diseases [PhD thesis]. Erasmus University Rotterdam; December 14, 2016.
2020	Dwyer MP. The Effect of Loss of Estrogen on Trabecular Bone Score in Women At Increased Risk of Breast Cancer [Master's thesis]. University of Toronto; 2020.