Trabecular bone score. Is it more reliable than densitometry in patients with spondyloarthritis?

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "X Nogués" "autores" => array:1 [ 0 => array:4 [ "nombre" => "X" "apellidos" => "Nogués" "email" => array:1 [ 0 => "xnogues@hospitaldelmar.cat" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital del Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Investigación Músculo-Esquelética (GIME), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES) Instituto Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universitat Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Puntuación de hueso trabecular. ¿Más fiable que la densitometría en pacientes con espondiloartritis?" ] ] "textoCompleto" => "The introduction of the analysis of bone microstructure by applying the trabecular bone score (TBS) has helped better define the risk of frailty fractures.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In their study entitled “Is the trabecular bone score useful for assessing bone quality in patients with axial spondyloarthritis and syndesmophytes?”, Palma-Sanchez et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> demonstrated that one of the major technical difficulties when evaluating the spine using densitometry can be overcome using the TBS.The degenerative changes that are produced in the spine (and specifically the syndesmophytes) change the dual-energy X-ray absorptiometry (DXA) densitometry values<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> and are one of the elements that cause false increases in bone mass. In a large cohort of postmenopausal women, Kolta et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> demonstrated that the TBS is not affected by the presence of osteoarthritis of the lumbar spine, following the classification of Kellgren and Lawrence<a class="elsevierStyleCrossRef" href="#bib0030">6</a> for assessing joint impairment, while bone mineral density (BMD) in the spine increases by 5.7% due to the presence of osteoarthritis.Other authors have also demonstrated this effect of overestimating the BMD due to osteoarthritis. In contrast, TBS is not affected and decreases with age, such that its value decreases by almost 9% among patients aged 52.5–77.5 years.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> It has also been shown that TBS in men is affected less than DXA by the presence of osteophytes and aortic calcifications, thereby reaffirming the usefulness of TBS as a risk factor for frailty fractures.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>The importance of performing the TBS analysis has also been evaluated in Spanish cohort studies such as FRODOS.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> In this study, the authors showed that 64.3% of women in the cohort with frailty fractures had a degraded TBS. TBS has also been employed to visualize changes produced by drugs such as aromatase inhibitors<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and corticosteroids<a class="elsevierStyleCrossRef" href="#bib0055">11</a> and by diseases such as primary hyperparathyroidism.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>Recently, Caparbo et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> showed that TBS and high-resolution peripheral quantitative tomography are highly useful for assessing bone mass and frailty in patients with sclerosing spondylitis, while DXA does not help quantify this loss due to artifacts produced by the disease itself.TBS has become a highly useful tool for assessing the risk of fracture and, combined with a bone mass measurement using DXA, helps differentiate patients who should start treatment due to their higher risk.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> The relevance of TBS has been proven in such a way that it has even been included in the Fracture Risk Assessment Tool for assessing the absolute risk of frailty fracture at 10 years.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>All contributions that improve the prediction of fractures and provide more accuracy to the diagnosis of osteoporosis are truly important. Implementing TBS in the various populations at risk of frailty fractures will help increase the understanding of this technique, which can be considered relatively novel. The contributions by Palma-Sanchez et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> supplement the existing data on TBS regarding spondyloarthritis<a class="elsevierStyleCrossRefs" href="#bib0025">5,8</a> and provide data on the Spanish population.We therefore have a fast and easy-to-implement element for conventional densitometers, which has few limitations for measuring bone frailty and fracture risk and will help us make the right decisions to prevent new osteoporotic fractures." "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-13" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Nogués X. Puntuación de hueso trabecular. ¿Más fiable que la densitometría en pacientes con espondiloartritis? 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