Editorial
The trabecular bone index: A new tool for assessing osteoporosis
El índice trabecular óseo: una nueva herramienta para la valoración de la osteoporosis
Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
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Olmos, J. González-Macías" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Olmos" "email" => array:1 [ 0 => "miromj@humv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "González-Macías" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El índice trabecular óseo: una nueva herramienta para la valoración de la osteoporosis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The trabecular bone score (TBS) is a measure that can be obtained from a bone densitometry image, provided by some dual-energy X-ray absorptiometry (DXA) densitometers. The score is related to the bone microarchitecture and provides additional information to conventional densitometry on bone texture.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,2</span></a> TBS quantifies the local variations in the pixels of the densitometry image of the lumbar spine and is derived from the experimental variograms obtained from the grayscale of these images. The densitometry images, obtained in 2 dimensions, are transformed into a 3-dimensional structure through a mathematical model. This score therefore measures the texture of the image, which is correlated with the 3D measurement of the trabecular structure.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> TBS is calculated in a few seconds from the DXA images, using specific software installed on the densitometer. One of the major advantages of this technique is the possibility of performing measurements based on images stored in the densitometer's memory, thereby obviating the need to repeat the densitometric study.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although this is a new technique and in the process of development, normality values have already been proposed for postmenopausal women. A TBS ≥1.350 is considered normal, 1.200–1.350 is considered indicative of a partially degraded bone microarchitecture, and <1.200 indicates manifested degradation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> Regardless, most authors believe that sufficiently large population studies need to be conducted to determine the optimal TBS values for various ages and for both sexes. In this issue of <span class="elsevierStyleSmallCaps">Revista Clínica Española</span>, Redondo et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> analyzed TBS values and their relationship with clinical characteristics, bone mineral density (BMD) and history of fractures in a cohort (FRODOS) of more than 2200 women between the ages of 59 and 70 years. In this interesting study, the authors determined that the mean TBS value was 1.203<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.121. More than half of these women showed degraded microarchitecture values, which were related to several clinical and anthropometric factors (age, weight and height), BMD, a history of frailty fractures, glucocorticoid treatment or the presence of type 2 diabetes mellitus.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The usefulness of this tool in clinical practice is becoming apparent. Various cross-sectional studies conducted with women have observed that TBS decreases with age<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,6</span></a> and is inversely correlated with the body mass index (BMI),<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> which is partly related to the effect of the soft tissues on the quality of the densitometric image used to calculate the TBS. Therefore, this technique is not recommended if the BMI is >37 or <15<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> This index is also lower in postmenopausal women with a history of osteoporotic fractures than in those who have no fractures, regardless of the spine's BMD.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Various prospective studies have observed that TBS predicts the risk of fracture in postmenopausal women. For example, the Manitoba study, which included almost 30,000 women, observed that those who developed a vertebral or hip fracture during follow-up presented a lower TBS and lower baseline lumbar bone mass than the women who did not develop fractures.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> In particular, the risk of experiencing any type of main osteoporotic fracture, adjusted by age, increased 33% for each reduction of a standard deviation of TBS. It was also observed that TBS was strongly associated with many of the risk factors for fracture incorporated in the fracture risk assessment tool (FRAX<span class="elsevierStyleSup">®</span>) of the World Health Organization, such as alcohol consumption, history of frailty fractures, the presence of rheumatoid arthritis, chronic obstructive pulmonary disease and the recent use of glucocorticoids.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> These authors subsequently determined that, after adjusting for the risk factors included in the FRAX<span class="elsevierStyleSup">®</span>, TBS continued to behave as an independent risk factor for fractures.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Moreover, the combination of BMD and TBS significantly improved the prediction of the fracture risk obtained with each individual parameter,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10,11</span></a> especially in younger individuals and those with normal densitometric values or values in the range of osteopenia.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,8,9</span></a> A similar observation was made in other cohorts, such as the <span class="elsevierStyleItalic">Os des Femmes de Lyon</span> (OFELY)<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> and European Multicenter Osteoporosis and Ultrasound (OPUS) studies.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> TBS has therefore been recently incorporated into the factors used by the FRAX tool to calculate the risk of osteoporotic fracture, which appears to improve the predictive capacity.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Another aspect that has started to be assessed is the behavior of TBS in response to osteoporotic treatment. However, most studies have shown that the changes to TBS induced by antiresorptive treatment are smaller than those observed in lumbar BMD, and these changes are weakly correlated with those of BMD. A similar result happens with bone-forming drugs. The International Society of Clinical Densitometry therefore does not recommend TBS when monitoring the response to osteoporotic treatment.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, a number of studies have suggested that assessing trabecular microarchitecture using TBS could be especially important for a number of specific conditions and diseases, such as diabetes mellitus, rheumatoid arthritis, primary hyperparathyroidism, chronic renal failure and glucocorticoid treatment.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, TBS is a new tool that can improve the prediction of the risk of osteoporotic fracture, which in turn can facilitate the therapeutic approach to this disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Olmos JM, González-Macías J. 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| Year/Month | Html | Total | |
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| 2023 March | 7 | 3 | 10 |
| 2020 September | 0 | 1 | 1 |
| 2018 April | 0 | 1 | 1 |
