Trabecular bone score: a useful clinical tool for the evaluation of skeletal health in women of short stature
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ORIGINAL ARTICLE
Trabecular bone score: a useful clinical tool for the evaluation of skeletal health in women of short stature Pedro Paulo Martins Alvarenga1,2 Barbara Campolina Silva 1,3,4 Mariana Picoli Diniz1 Milena Bellei Leite1 Caroline Alves Moreira da Silva1 Jessica de Cássia Mendes Eleutério1 Maria Marta Sarquis Soares2,3 John P. Bilezikian5 Bruno Muzzi Camargos6 ●
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Received: 8 April 2019 / Accepted: 1 July 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose Areal bone mineral density (aBMD) by DXA is underestimated in those with smaller bones and overestimated in those with larger bones. Trabecular bone score (TBS) predicts fracture risk, and is not influenced by bone size. The aim of this study was to evaluate TBS and BMD in women with short stature. Methods We retrospectively analyzed DXA scans of all women aged 50–90 years with short stature (161 cm in height, matched for age and LS BMD, selected from the same database. Results The study population included 342 women. The two groups were similar in age, and aBMD at the LS and total hip. Femoral neck aBMD was lower in cases than in taller women. In contrast, TBS was higher in women with short stature than in their taller counterparts (1.347 ± 0.102 vs. 1.250 ± 0.110; p < 0.001). Bone mineral apparent density (BMAD) and the LS TBS-adjusted BMD T-score were also significantly higher in shorter than in taller women. From the entire cohort, 121 women (67 cases) were osteoporotic by aBMD determinations. Among these subjects, TBS was also greater in cases (1.303 ± 0.103) than in women with standard height (1.190 ± 0.099; p < 0.001). Despite being considered osteoporotic, 36% of short women, but none of the taller ones, had a normal TBS. Conclusions TBS can be a useful adjunct to aBMD for assessing bone quality in short women, in whom aBMD measurement tends to read lower, and, thus could overestimate fracture risk. Keywords Trabecular bone score DXA Short stature Fracture risk Osteoporosis ●
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Introduction Low bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) is a strong predictor of fracture risk,
These authors contributed equally: Pedro Paulo Martins Alvarenga, Barbara Campolina Silva * Barbara Campolina Silva [email protected] 1
School of Medicine, Centro Universitário de Belo Horizonte – UNI-BH, Belo Horizonte, Brazil
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Department of Medicine, Federal University of Minas Gerais – UFMG –, Belo Horizonte, Brazil
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Division of Endocrinology, Hospital Felicio Rocho, Belo Horizonte, Brazil
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and in addition to serving as a diagnostic criterion, a BMD T-score ≤ −2.5 is a widely accepted threshold for pharmacological intervention in osteoporosis [1, 2]. Despite being widely used for the assessment of fracture risk in clinical medicine, the measurement of BMD by DXA has disadvantages. It cannot assess other skeletal indices, such as the rate of bone turnover, bone microarchitecture, and microdamage, all of which are importantly rela
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