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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The introduction of the analysis of bone microstructure by applying the trabecular bone score &#40;TBS&#41; has helped better define the risk of frailty fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In their study entitled &#8220;<span class="elsevierStyleItalic">Is the trabecular bone score useful for assessing bone quality in patients with axial spondyloarthritis and syndesmophytes&#63;&#8221;</span>&#44; Palma-Sanchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> demonstrated that one of the major technical difficulties when evaluating the spine using densitometry can be overcome using the TBS&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The degenerative changes that are produced in the spine &#40;and specifically the syndesmophytes&#41; change the dual-energy X-ray absorptiometry &#40;DXA&#41; densitometry values<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> and are one of the elements that cause false increases in bone mass&#46; In a large cohort of postmenopausal women&#44; Kolta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> demonstrated that the TBS is not affected by the presence of osteoarthritis of the lumbar spine&#44; following the classification of Kellgren and Lawrence<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> for assessing joint impairment&#44; while bone mineral density &#40;BMD&#41; in the spine increases by 5&#46;7&#37; due to the presence of osteoarthritis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Other authors have also demonstrated this effect of overestimating the BMD due to osteoarthritis&#46; In contrast&#44; TBS is not affected and decreases with age&#44; such that its value decreases by almost 9&#37; among patients aged 52&#46;5&#8211;77&#46;5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It has also been shown that TBS in men is affected less than DXA by the presence of osteophytes and aortic calcifications&#44; thereby reaffirming the usefulness of TBS as a risk factor for frailty fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The importance of performing the TBS analysis has also been evaluated in Spanish cohort studies such as FRODOS&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In this study&#44; the authors showed that 64&#46;3&#37; of women in the cohort with frailty fractures had a degraded TBS&#46; TBS has also been employed to visualize changes produced by drugs such as aromatase inhibitors<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and corticosteroids<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and by diseases such as primary hyperparathyroidism&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently&#44; Caparbo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> showed that TBS and high-resolution peripheral quantitative tomography are highly useful for assessing bone mass and frailty in patients with sclerosing spondylitis&#44; while DXA does not help quantify this loss due to artifacts produced by the disease itself&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">TBS has become a highly useful tool for assessing the risk of fracture and&#44; combined with a bone mass measurement using DXA&#44; helps differentiate patients who should start treatment due to their higher risk&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></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&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">All contributions that improve the prediction of fractures and provide more accuracy to the diagnosis of osteoporosis are truly important&#46; Implementing TBS in the various populations at risk of frailty fractures will help increase the understanding of this technique&#44; which can be considered relatively novel&#46; The contributions by Palma-Sanchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> supplement the existing data on TBS regarding spondyloarthritis<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a> and provide data on the Spanish population&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We therefore have a fast and easy-to-implement element for conventional densitometers&#44; which has few limitations for measuring bone frailty and fracture risk and will help us make the right decisions to prevent new osteoporotic fractures&#46;</p></span>"
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DOI: 10.1016/j.rceng.2019.06.003
Trabecular bone score. Is it more reliable than densitometry in patients with spondyloarthritis?
Puntuación de hueso trabecular. ¿Más fiable que la densitometría en pacientes con espondiloartritis?
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X Noguésa,b,c,d
a Servicio de Medicina Interna, Hospital del Mar, Barcelona, Spain
b Grupo de Investigación Músculo-Esquelética (GIME), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
c CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES) Instituto Carlos III, Madrid, Spain
d Universitat Autónoma de Barcelona, Barcelona, Spain
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