Reference Ranges for Trabecular Bone Score in Australian Men and Women: A Cross‐Sectional Study

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ABSTRACT

Trabecular bone score (TBS) is a novel method for indirectly assessing trabecular microarchitecture at the lumbar spine, providing information complementary to areal BMD. However, limited reference ranges exist for the normative distribution of TBS, particularly in men. The aim of this study was to develop such a reference range in Australian men and women. This study included 894 men and 682 women (aged 24 to 98 years) enrolled in the Geelong Osteoporosis Study. TBS was determined retrospectively by analysis of lumbar spine DXA scans (Lunar Prodigy) using TBS iNsight software (version 2.2). Multivariable regression techniques were used to determine best‐fit models for TBS incorporating age, height, and weight. Age‐related differences in TBS were best modelled with a linear relationship in men and a cubic relationship in women. Combined best‐fit models for TBS included age and weight in men, and age and height in women. This study provides normative reference ranges for TBS in Australian men and women, and further indicates that TBS may identify individuals at risk for fracture despite normal BMD. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Most cited references 6

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Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture.

Didier Hans, Laurent Pothuaud, Pascal Carceller (2008)

X-ray imaging remains a very cost-effective technique, with many applications in both medical and material science. However, the physical process of X-ray imaging transforms (e.g. projects) the 3-dimensional (3D) microarchitecture of the object or tissue being studied into a complex 2D grey-level texture. The 3D/2D projection process continues to be a difficult mathematical problem, and neither demonstrations nor well-established correlations have positioned 2D texture analysis-based measurement as a valid indirect evaluation of 3D microarchitecture. The trabecular bone score (TBS) is a new grey-level texture measurement which utilizes experimental variograms of 2D projection images. The aim of the present study was to determine the level of correlation between the 3D characteristics of trabecular bone microarchitecture, as evaluated using muCT reconstruction, and TBS, as evaluated using 2D projection images derived directly from 3D muCT reconstruction. Analyses were performed using sets of human cadaver bone samples from different anatomical sites (lumbar spine, femoral neck, and distal radius). Significant correlations were established via standard multiple regression analysis, and via the use of a generic mathematical 3D/2D relationship. In both instances, the correlations established a significant relationship between TBS and two 3D characteristics of bone microarchitecture: bone volume fraction and mean bone thickness. In particular, it appears that TBS permits to accurately differentiate between two 3D microarchitectures that exhibit the same amount of bone, but different trabecular characteristics. These results demonstrate the existence of a robust and generic relationship, taking into consideration a simplified model of a 2D projection image. Ultimately, this may lead to using TBS measurements directly on DXA images obtained in routine clinical practice.

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The population burden of fractures originates in women with osteopenia, not osteoporosis.

Elizabeth N Merriman, Nancy Henry, Mark A. Kotowicz … (2005)

Osteoporosis is associated with increased risk for fracture. However, most postmenopausal women have bone mineral density (BMD) within the normal or osteopenic range. The aim of this study was to determine the proportion of the population burden of fragility fractures arising from women at modest risk for fracture. We measured baseline BMD in a population-based random sample of 616 postmenopausal women aged 60-94 years and followed these individuals for a median of 5.6 years (IQR 3.9-6.5) to determine the incidence of fractures according to age, BMD and the presence of a prior fracture. Based on WHO criteria, 37.6% of the women had normal total hip BMD, 48.0% had osteopenia and 14.5% had osteoporosis. The incidence of fracture during follow-up was highest in women with osteoporosis, but only 26.9% of all fractures arose from this group; 73.1% occurred in women without osteoporosis (56.5% in women with osteopenia, 16.6% in women with normal BMD). Decreasing BMD, increasing age and prior fracture contributed independently to increased fracture risk; in a multivariate model, the relative risk for fracture increased 65% for each SD decrease in BMD (RR=1.65, 95%CI 1.32-2.05), increased 3% for every year of age (RR=1.03, 95%CI 1.01-1.06) and doubled with prevalent fracture (RR=2.01, 95% CI 1.40-2.88). A prevalent fracture increased the risk for fractures such that women with osteopenia and prevalent fracture had the same, if not greater, risk as women with osteoporosis alone. Reducing the population burden of fractures requires attention to women with osteopenia, as well as osteoporosis, because over half of the fragility fractures in the population arise in these individuals, and women with osteopenia plus a prevalent fracture have the same fracture risk as women with osteoporosis.

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Prevalence of osteoporosis in Australian women: Geelong Osteoporosis Study.

Ryan Henry, Andrew G Nicholson, Ego Seeman … (1999)

To evaluate the prevalence of osteoporosis at various sites among Australian women, cross-sectional bone mineral density (BMD) data for adult females was obtained from an age-stratified population-based sample (n = 1494; 20-94 yr) drawn at random from the Barwon Statistical Division, a population characteristic of Australia. Age- and weight- (and for three sites, height) matched reference ranges for BMD at the lumbar spine, proximal femur, forearm, and total body were developed using regression techniques. The cutoff BMD level for osteoporosis at the PA spine was 0. 917g/cm(2) and 0.713 g/cm(2) at the femoral neck according to the World Health Organization (WHO) guidelines. The upper cutoff level for osteopenia was 1.128 g/cm(2) at the PA spine and 0.913g/cm(2) for the femoral neck. The proportion of Australian women categorized as having osteoporosis at the PA spine, femoral neck, or midforearm ranged from 0.9% among those aged 40-44 yr to 87.0% for those older than 79 yr. This study provides reference data representative of the Australian female population. A large proportion of elderly Australian women has osteoporosis according to the WHO guidelines.

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Author and article information

Contributors

Kara B Anderson: kara.anderson@barwonhealth.org.au

Journal

Journal ID (nlm-ta): JBMR Plus

Journal ID (iso-abbrev): JBMR Plus

Journal ID (doi): 10.1002/(ISSN)2473-4039

Journal ID (publisher-id): JBM4

Title: JBMR Plus

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2473-4039

Publication date (Electronic): 15 January 2019

Publication date Collection: June 2019

Volume: 3

Issue: 6 ( doiID: 10.1002/jbm4.v3.6 )

Electronic Location Identifier: e10133

Affiliations

[ ¹ ] Deakin University, School of Medicine Geelong Australia

[ ² ] Center of Bone Diseases, Bone & Joint Department Lausanne University Hospital Lausanne Switzerland

[ ³ ] Barwon Health Geelong Australia

[ ⁴ ] Department of Medicine Western Campus The University of Melbourne St Albans Australia

[ ⁵ ] Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia

Author notes

[*] [* ] Address correspondence to: Kara B Anderson, BHlth&MedSci(Hons), Epi‐Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University, PO Box 281 Box 281 (Barwon Health), Geelong VIC 3220, Australia. E‐mail: kara.anderson@ 123456barwonhealth.org.au

Article

Publisher ID: JBM410133

DOI: 10.1002/jbm4.10133

PMC ID: 6636769

PubMed ID: 31346565

SO-VID: e296c0ed-cebb-43ae-8e08-88a27b0c4f1e

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 August 2018

Date revision received : 13 November 2018

Date accepted : 27 November 2018

Page count

Figures: 3, Tables: 3, Pages: 6, Words: 3645

Funding

Funded by: Alfred Deakin Postdoctural Research Fellowship

Funded by: Australian Postgraduate Award

Funded by: Perpetual Trustees

Funded by: Arthritis Foundation of Australia

Funded by: National Health and Medical Research Council

Award ID: 251638

Award ID: 299831

Award ID: 628582

Funded by: Geelong Regional Medical Foundation

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source-schema-version-number 2.0

component-id jbm410133

cover-date June 2019

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.6.1 mode:remove_FC converted:17.07.2019

Reference Ranges for Trabecular Bone Score in Australian Men and Women: A Cross‐Sectional Study

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Most cited references 6

Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture.

The population burden of fractures originates in women with osteopenia, not osteoporosis.

Prevalence of osteoporosis in Australian women: Geelong Osteoporosis Study.

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