Utility of the trabecular bone score (TBS) in secondary osteoporosis
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ENDOCRINE METHODS AND TECHNIQUES
Utility of the trabecular bone score (TBS) in secondary osteoporosis Fabio M. Ulivieri • Barbara C. Silva • Francesco Sardanelli • Didier Hans • John P. Bilezikian • Renata Caudarella
Received: 5 February 2014 / Accepted: 25 April 2014 Ó Springer Science+Business Media New York 2014
Abstract Altered bone micro-architecture is an important factor in accounting for fragility fractures. Until recently, it has not been possible to gain information about skeletal microstructure in a way that is clinically feasible. Bone biopsy is essentially a research tool. High-resolution peripheral Quantitative Computed Tomography, while non-invasive, is available only sparsely throughout the world. The trabecular bone score (TBS) is an imaging technology adapted directly from the Dual Energy X-Ray Absorptiometry (DXA) image of the lumbar spine. Thus, it is potentially readily and widely available. In recent years, a large number of studies have demonstrated that TBS is significantly associated with direct measurements of bone micro-architecture, predicts current and future fragility fractures in primary osteoporosis, and may be a useful F. M. Ulivieri Bone Metabolic Unit, Division of Nuclear Medicine, Fondazione Irccs Ca’ Ospedale Maggiore Policlinico, Milan, Italy B. C. Silva J. P. Bilezikian Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA F. Sardanelli Radiologiy Unit, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milan, San Donato Milanese, Milan, Italy D. Hans (&) Center of Bone Diseases, Division of Rheumatology, Department of Bones and Joints, Lausanne University Hospital, Avenue Pierre Decker 4, 1011 Lausanne, Switzerland e-mail: [email protected] R. Caudarella Maria Cecilia Hospital GVM Care and Research, Cotignola, RA, Italy
adjunct to BMD for fracture detection and prediction. In this review, we summarize its potential utility in secondary causes of osteoporosis. In some situations, like glucocorticoid-induced osteoporosis and in diabetes mellitus, the TBS appears to out-perform DXA. It also has apparent value in numerous other disorders associated with diminished bone health, including primary hyperparathyroidism, androgen-deficiency, hormone-receptor positive breast cancer treatment, chronic kidney disease, hemochromatosis, and autoimmune disorders like rheumatoid arthritis. Further research is both needed and warranted to more clearly establish the role of TBS in these and other disorders that adversely affect bone. Keywords Secondary osteoporosis Trabecular bone score Bone quality Glucocorticoids Primary hyperparathyroidism Rheumatoid arthritis Chronic kidney disease Diabetes mellitus Abbreviations 2D Two-dimensional 3D Three-dimensional AUC Area under the curve BMD Bone mineral density BMI Body mass index Conn.D Connectivity density CT Computed tomography DXA Dual energy X-ray absorptiometry FEA Finite element anal
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