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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoporosis is a skeletal disorder characterized by reduced bone mass and quality&#44; which entails lower bone resistance and increased risk of fracture&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> In postmenopausal women&#44; the diagnosis of osteoporosis is established based on the results of bone densitometry using the dual energy X-ray absorptiometry &#40;DXA&#41; technique&#44; which classifies bone constitution in the range of normality&#44; osteopenia or osteoporosis&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> This classification&#44; created by the World Health Organization in 1994&#44; is also used as the therapeutic threshold and for the assessment of fracture risk and is based on the linear relationship between lower bone mineral density &#40;BMD&#41; and the development of fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> However&#44; approximately 50&#37; of fractures due to frailty observed in follow-up cohort studies occur in individuals whose BMD is in the osteopenia range and even in the normal range&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The results provided by bone densitometry therefore do not establish with acceptable accuracy that individuals are more prone to experiencing fractures&#46; In recent years&#44; risk scales have been created that add other factors involved in the pathogenesis of fractures &#40;age&#44; body mass index&#44; previous fractures&#44; use of glucocorticoids&#44; etc&#46;&#41; to densitometry&#59; however&#44; their predictive capacity usually does not exceed 70&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6</span></a> It can therefore be inferred that when a fracture is caused by frailty there is deficient bone quality and resistance&#46; It has been suggested that trabecular bone microarchitecture abnormalities&#44; not detected by densitometry&#44; could be at least partially responsible for this lower resistance and poorer quality of bone tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the search for elements that could improve the information provided by DXA densitometry&#44; a trabecular bone structure score system has been recently described&#58; the trabecular bone score &#40;TBS&#41;&#46; TBS is a texture parameter that reflects the greyscale variations in the pixels from DXA images&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> These variations indirectly show the condition of the bone microarchitecture&#46; A lower TBS is associated with a low number of trabeculae and a weaker connection between them&#44; while high values are correlated with a stronger trabecular structure&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> TBS&#44; as with BMD&#44; decreases with age and has been slightly but significantly associated&#44; both in retrospective and prospective studies&#44; with the development of fractures&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">10&#8211;14</span></a> Furthermore&#44; in disorders that only slightly change BMD but are associated with a greater risk of fracture&#44; such as type 2 diabetes mellitus &#40;DM2&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> and glucocorticoid treatment&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> it has been suggested that TBS improves the identification of patients with a risk of fracture&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although a number of Spanish clinical studies have been published on the usefulness of TBS&#44;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;17&#8211;19</span></a> there have been no population studies on TBS in postmenopausal women in Spain&#46; The aim of this study was to analyze the TBS of a cohort population of postmenopausal women &#40;Osteoporotic Fractures of Osona &#91;FRODOS&#93; cohort&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">20&#8211;22</span></a> created to study the risk of osteoporotic fracture&#44; and relate the values to the clinical characteristics&#44; BMD values and history of fractures in this population group&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The FRODOS cohort was designed to study the risk factors for frailty fractures in postmenopausal women of the Osona region &#40;Barcelona&#44; Spain&#41;&#46; The cohort consisted of a baseline cohort recruited between 2006 and 2009 &#40;2968 women between the ages of 59 and 70 years&#41; and a follow-up group between 2011 and 2013 &#40;2510 women&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; in which the participants signed an informed consent document&#46; The selection criteria and the cohort&#39;s characteristics have been described in previous publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">20&#8211;22</span></a> In the present study&#44; we analyzed several clinical and densitometric parameters from the 2510 participants who completed the follow-up period&#46; The study was approved by the clinical research ethics committee of the Osona Foundation for Healthcare Research and Education &#40;FORES&#41; &#40;reference 2014&#47;858-PR88&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The main study parameters included the following&#58; a clinical-epidemiological survey on the risk factors for osteoporosis and a history of postmenopausal fractures&#44; anthropometric data &#40;weight&#44; height and body mass index &#91;BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#93;&#41;&#44; bone densitometry in the lumbar spine and femur and the prevalence of vertebral fractures using morphometry&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a> We specifically added the variable &#8220;frailty fractures&#8221;&#44; which included women who reported a history of postmenopausal fractures in the initial survey and those with vertebral fractures found during the baseline study using vertebral DXA morphometry&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Densitometry</span><p id="par0035" class="elsevierStylePara elsevierViewall">The DXA densitometries of the lumbar spine &#40;L1&#8211;L4&#41; and proximal femur &#40;total femur and femoral neck&#41; were obtained with a GE Lunar Prodigy Advance densitometer&#44; which has the standardized databases for the Spanish population&#46; According to the World Health Organization criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> we established the following diagnostic categories&#58; normal value &#40;<span class="elsevierStyleItalic">T</span> score<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#41;&#44; osteopenia &#40;<span class="elsevierStyleItalic">T</span> score between &#8722;1 and &#8722;2&#46;5&#41; and osteoporosis &#40;<span class="elsevierStyleItalic">T</span> score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#46;5&#41;&#46; For the osteoporosis and osteopenia diagnosis&#44; we considered the lowest value detected in any of the 2 locations &#40;lumbar spine and femur&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evaluation of the trabecular bone score</span><p id="par0040" class="elsevierStylePara elsevierViewall">We applied TBS iNsight Clinical Data Analyzer software &#40;version 2&#46;1&#46;0&#46;2&#44; Medimaps&#41; on the baseline DXA images and calculated the mean TBS in L1&#8211;L4&#46; The TBS &#40;expressed in arbitrary units&#41; were grouped into 3 categories&#58; TBS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;310&#44; normal microarchitecture&#59; TBS between 1&#46;230 and 1&#46;310&#44; partially deteriorated microarchitecture&#59; and TBS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#46;230&#44; degraded microarchitecture&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a> We excluded 253 women &#40;10&#46;1&#37;&#41; with a BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> from the analysis due to the lack of TBS validation for this population subgroup&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of the sample&#44; calculating the frequencies and percentages of each categorical variable&#46; For the quantitative variables&#44; we calculated the mean and standard deviation&#46; We performed a bivariate analysis to identify the variables associated with the TBS&#46; To analyze the relationship between the TBS and the categorical variables&#44; we used Student&#39;s <span class="elsevierStyleItalic">t</span>-test or ANOVA and simple linear regressions&#46; To analyze the relationship between the TBS and the quantitative variables&#44; we calculated Pearson&#39;s correlation coefficient and simple linear regressions&#46; We then performed a multiple linear regression with the significant variables in the univariate models&#46; All statistical tests were performed with a 95&#37; significance level&#46; For the statistical analysis&#44; we employed the Statistical Package for the Social Sciences software &#40;version 21&#46;0 for Windows&#44; released 2012&#59; IBM Corp&#46;&#44; Armonk&#44; NY&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the characteristics of the 2257 women included in the study&#46; Some 18&#46;8&#37; of the women had normal BMD values&#44; 51&#46;3&#37; had osteopenia&#44; and 29&#46;9&#37; had osteoporosis&#46; It is worth noting that 8&#46;8&#37; had DM2&#44; and 5&#46;4&#37; were undergoing glucocorticoid treatment&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Some 19&#46;1&#37; of the women &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>430&#41; had a history of postmenopausal fractures&#44; and 4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90&#41; had prevalent vertebral fractures in the morphometric study &#40;analyzed using DXA&#41;&#46; Additionally&#44; 1&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41; of the participants presented both types of fractures&#59; ultimately&#44; 482 women had frailty fractures&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The mean TBS was 1&#46;203<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;121&#46; Some 18&#46;2&#37; of the participants had normal values&#44; 26&#46;5&#37; had values indicating partially deteriorated microarchitecture&#44; and 55&#46;3&#37; had values indicating degraded microarchitecture&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the women with osteoporosis&#44; the TBS was 1&#46;157<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&#59; in those with osteopenia&#44; the TBS was 1&#46;213<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&#59; and in the women with normal densitometry&#44; the TBS was 1&#46;245<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Additionally&#44; 71&#37; of the women with densitometric osteoporosis had degraded microarchitecture&#44; a finding that was observed in 51&#37; of the women with osteopenia and 42&#46;1&#37; of those with normal BMD &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The women with DM2 and those undergoing glucocorticoid treatment had significantly lower TBS than the other participants &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Similarly&#44; the women with frailty fractures &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>482&#41; showed significantly lower TBS than those without fractures &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Furthermore&#44; most of the women with frailty fractures &#40;64&#46;3&#37;&#41; had a degraded TBS&#44; while only 18&#46;1&#37; of the women with normal TBS presented a history of these fractures&#46; This finding was even more frequent when we analyzed the women with frailty fractures and the concomitant presence of degraded TBS and osteoporosis or osteopenia&#46; Therefore&#44; while only 3&#46;2&#37; of the women with frailty fractures concomitantly had a normal TBS and bone densitometry&#44; 58&#46;3&#37; of those with fractures had a degraded TBS associated with the presence of osteoporosis or osteopenia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We observed a direct linear relationship between the TBS and BMD&#46; There was an inverse relationship between TBS and the variables of age&#44; height and weight &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; As the age&#44; height and weight increased&#44; the TBS decreased&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the univariate linear regression analysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; the factors associated with TBS were age&#44; height&#44; weight&#44; BMD&#44; lumbar <span class="elsevierStyleItalic">T</span> score&#44; use of glucocorticoids&#44; DM2&#44; a history of postmenopausal fractures&#44; a prevalence of vertebral fractures and frailty fractures&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the multiple linear regression analysis&#44; most of the risk factors identified in the univariate analysis remained significant&#44; except for lumbar BMD &#40;expressed in g&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; prevalent vertebral fractures and postmenopausal fractures considered in isolation&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The present study shows that&#44; in a cohort of Spanish postmenopausal women created to study the risk factors of osteoporotic fracture&#44; the mean TBS lies within microarchitecture degradation scores and is related to several clinical and anthropometric factors such as age&#44; weight&#44; height&#44; BMD&#44; a history of frailty fracture&#44; glucocorticoid treatment and the presence of DM2&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">TBS is a new technique that measures bone texture parameters that are extracted from DXA studies of the lumbar spine and provides an indirect index of the trabecular bone microarchitecture&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;15</span></a> It has been suggested that TBS could also be a complementary technique for BMD quantification using DXA to better estimate the risk of fracture&#44; especially in individuals with normal or osteopenic densitometry values&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4&#44;7</span></a> given that TBS could theoretically provide additional information on bone quality not reflected in the BMD&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The clinical studies in Spain on TBS have confirmed its usefulness in certain patient groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;17&#8211;19</span></a> In this study of 2510 postmenopausal women&#44; which excluded those with a BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;the increase in abdominal fat can distort the TBS results&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> the values of this index are inversely related to age&#44; weight and height and positively related to BMD&#44; as has been reported in most population studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;24&#44;25</span></a> These studies have shown similar results in terms of the intensity of the association between TBS and age&#44; while the positive relationship with BMD varies according to the anatomical region studied and the participant&#39;s epidemiological characteristics&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">With regard to the clinical variables&#44; a history of a frailty fracture was significantly associated with a lower TBS&#44; both in the univariate and multivariate analysis&#46; Furthermore&#44; most of the women with a history of fractures had a degraded TBS&#44; and in fact only 18&#37; of these had normal values&#46; Although the relationship between TBS and BMD and&#47;or lumbar <span class="elsevierStyleItalic">T</span> score was weakly positive&#44; most of the patients with densitometric osteoporosis &#40;approximately 71&#37;&#41; had a degraded microarchitecture&#44; a finding that was also observed in 50&#37; of the women with osteopenia&#46; This suggests that TBS could provide complementary information for assessing the risk of fracture in this population group&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">It is noteworthy that the TBS for the women with DM2 were significantly lower than those of the participants without this disease&#46; In recent years&#44; an increase has been reported in the risk of fractures in patients with diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> However&#44; these patients usually present relatively higher BMD values than expected based on the actual rate of fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> This fact suggests that there are other mechanisms&#44; which are not reflected in the BMD&#44; that are involved in the increase in bone frailty of patients with diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> Similar to our findings&#44; recent studies have shown a reduction in TBS in this population group and have suggested that it could be a useful technique in identifying patients with a risk of fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The participants who were taking glucocorticoids also had significantly lower TBS than those who were not taking them&#46; The consumption of glucocorticoids is the most common cause of secondary osteoporosis and entails an increase in the risk of fractures&#44; mainly vertebral&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> The pathogenesis of corticosteroid osteoporosis is complex and has been related to several factors such as the underlying disease&#44; the patients&#8217; clinical characteristics&#44; the dosage and treatment time&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">31&#44;32</span></a> The pathophysiology is multifactorial and is associated with a pronounced reduction in bone formation&#44; which leads to reduced bone mass&#44; along with a deterioration in other qualitative aspects of bone tissue that increase its frailty&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> In this respect&#44; and similar to what happens for patients with diabetes&#44; patients treated with glucocorticoids have fractures with relatively high BMD values&#44; which impedes their preventive treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> In agreement with our results&#44; other authors have reported a reduction in TBS in patients who take glucocorticoids&#44; indicating that this imaging technique could be beneficial in this population subgroup for identifying patients with an increased risk of fracture&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">This study has strengths and limitations&#46; Its strengths include the sample size&#44; the cohort&#39;s populational nature and the confirmation of the main associations of TBS in a Spanish population with osteoporosis&#46; The limitations are those inherent in a cohort study that analyzes in a cross-sectional manner the results of a new technique&#46; The study might have selection or baseline and longitudinal biases that could affect its results&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion&#44; in the FRODOS cohort composed of women between the ages of 59 and 70 years&#44; the TBS was mostly located in the degraded microarchitecture category&#44; in relation to aging and reduced BMD&#46; Low TBS were more common in the participants with a history of fracture&#44; those who had undergone glucocorticoid treatment and those who had DM2&#46; These results&#44; consistent with recent studies&#44; suggest that this index could be a useful tool for assessing the risk of osteoporotic fracture&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This project was partly funded by the Ministry of Science and Innovation &#8211; Health Institute Carlos <span class="elsevierStyleSmallCaps">III</span>&#8211; PI10&#47;00034 and by the Spanish Society for Bone and Mineral Metabolism Research &#8211; Project SEIOMM &#8211; TBS 2014&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The trabecular bone score &#40;TBS&#41; is an imaging technique that assesses the condition of the trabecular microarchitecture&#46; Preliminary results suggest that TBS&#44; along with the bone mineral density assessment&#44; could improve the calculation of the osteoporotic fracture risk&#46; The aim of this study was to analyze TBS values and their relationship with the clinical characteristics&#44; bone mineral density and history of fractures of a cohort of posmenopausal women&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We analyzed 2257 posmenopausal women from the FRODOS cohort&#44; which was created to determine the risk factors for osteoporotic fracture through a clinical survey and bone densitometry with vertebral morphometry&#46; TBS was applied to the densitometry images&#46; TBS values &#8804;1230 were considered indicative of degraded microarchitecture&#46; We performed a simple and multiple linear regression to determine the factors associated with this index&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean TBS value in L1&#8211;L4 was 1&#46;203<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;121&#46; Some 55&#46;3&#37; of the women showed values indicating degraded microarchitecture&#46; In the multiple linear regression analysis&#44; the factors associated with low TBS values were age&#44; weight&#44; height&#44; spinal <span class="elsevierStyleItalic">T</span>-score&#44; glucocorticoid treatment&#44; presence of type 2 diabetes and a history of fractures due to frailty&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">TBS showed microarchitecture degradation values in the participants of the FRODOS cohort and was associated with anthropometric factors&#44; low bone mineral density values&#44; the presence of fractures&#44; a history of type 2 diabetes mellitus and the use of glucocorticoids&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El <span class="elsevierStyleItalic">Trabecular Bone Score</span> &#40;TBS&#41; es una t&#233;cnica de imagen que eval&#250;a el estado de la microarquitectura trabecular&#46; Resultados preliminares sugieren que&#44; junto a la valoraci&#243;n de la densidad mineral &#243;sea&#44; podr&#237;a mejorar la estimaci&#243;n del riesgo de fractura ostopor&#243;tica&#46; El objetivo de este estudio fue analizar los valores de TBS y su relaci&#243;n con las caracter&#237;sticas cl&#237;nicas&#44; densidad mineral &#243;sea y antecedentes de fracturas en una cohorte de mujeres posmenop&#225;usicas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analizamos 2&#46;257 mujeres posmenop&#225;usicas procedentes de la cohorte FRODOS&#44; constituida para determinar los factores de riesgo de fractura osteopor&#243;tica mediante una encuesta cl&#237;nica y densitometr&#237;a &#243;sea con morfometr&#237;a vertebral&#46; Se aplic&#243; el TBS a las im&#225;genes densitom&#233;tricas&#46; Valores de TBS &#8804;1&#44;230 se consideraron indicativos de microarquitectura degradada&#46; Se realiz&#243; una regresi&#243;n lineal simple y m&#250;ltiple para determinar los factores asociados con este &#237;ndice&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El valor medio de TBS en L1-L4 fue de 1&#44;203<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;121&#46; El 55&#44;3&#37; de las mujeres presentaban valores de microarquitectura degradada&#46; En el an&#225;lisis de regresi&#243;n lineal m&#250;ltiple los factores asociados a los valores bajos de TBS fueron la edad&#44; el peso&#44; la altura&#44; escala T de columna lumbar&#44; tratamiento con glucocorticoides&#44; presencia de diabetes tipo 2 y antecedentes de fractura por fragilidad&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El TBS mostr&#243; valores de microarquitectura degradada en las participantes de la cohorte FRODOS y se asoci&#243; a factores antropom&#233;tricos&#44; valor bajo de densidad mineral &#243;sea&#44; presencia de fracturas&#44; antecedentes de diabetes mellitus tipo 2 y uso de glucocorticoides&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Redondo L&#44; Puigoriol E&#44; Rodr&#237;guez JR&#44; Peris P&#44; Kanterewicz E&#46; Utilidad del <span class="elsevierStyleItalic">Trabecular Bone Score</span> en la valoraci&#243;n del riesgo de fractura osteopor&#243;tica&#46; Rev Clin Esp&#46; 2018&#59;218&#58;121&#8211;127&#46;</p>"
      ]
    ]
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        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">FRODOS cohort diagram&#46;</p>"
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Trabecular bone score and bone mineral density&#46; &#40;a&#41; A TBS according to the densitometric categories&#46; &#40;b&#41; Correlation between TBS and lumbar T scale in women with frailty fractures&#46;</p>"
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The values are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; BMD&#44; bone mineral density&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Weight&#44; kg</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Height&#44; cm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">155&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Fracture in postmenopause</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">430 &#40;19&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prevalence of vertebral fractures</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;4&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Frailty fractures</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">482 &#40;21&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Glucocorticoid treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121 &#40;5&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">199 &#40;8&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lumbar BMD&#44; g&#47;cm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;990<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lumbar spine T score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;1&#46;591<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">425 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Osteopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1158 &#40;51&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">674 &#40;29&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">430 women with fractures in postmenopause&#44; 90 women with prevalence of vertebral fractures of which 38 &#40;1&#46;7&#37;&#41; are cases of coinciding fractures&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the study population&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 2"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; BMD&#44; bone mineral density&#59; TBS&#44; trabecular bone score&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TBS values &#8211; clinical variables<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></th></tr><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TBS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Fracture in postmenopause</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;208<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;179<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Prevalence of vertebral fractures</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;204<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;161<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Frailty fractures</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;210<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;176<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Glucocorticoid treatment</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;205<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;167<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Diabetes</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;208<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;150<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">BMD</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;245<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">&#60;&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Osteopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;213<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;157<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Coefficients of correlation TBS &#8211; anthropometric and densitometric variables<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a></th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">&#961;</span> Pearson correlation coefficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lumbar BMD&#44; g&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;261&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:3 [
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Student&#39;s <span class="elsevierStyleItalic">t</span>-test or ANOVA&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Pearson correlation coefficient&#46;</p> <p class="elsevierStyleNotepara" id="npar0020">The tests were considered statistically significant when <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p>"
            ]
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Association of the Trabecular Bone Score with clinical&#44; anthropometric and densitometric variables&#46;</p>"
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      ]
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; BMD&#44; bone mineral density&#59; CI&#44; confidence interval&#59; DM2&#44; type 2 diabetes mellitus&#59; TBS&#44; trabecular bone score&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">&#946;</span> &#40;95&#37; CI&#41; multivariate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;007 &#40;&#8722;0&#46;008&#59; &#8722;0&#46;005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;005 &#40;&#8722;0&#46;007&#59; &#8722;0&#46;004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;003 &#40;&#8722;0&#46;004&#59; &#8722;0&#46;003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;002 &#40;&#8722;0&#46;003&#59; &#8722;0&#46;002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;003 &#40;&#8722;0&#46;004&#59; &#8722;0&#46;003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lumbar BMD&#44; g&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lumbar spine <span class="elsevierStyleItalic">T</span> score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023 &#40;0&#46;020&#59; 0&#46;027&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;034 &#40;0&#46;030&#59; 0&#46;037&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucocorticoid treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;038 &#40;&#8722;0&#46;061&#59; &#8722;0&#46;016&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;036 &#40;&#8722;0&#46;056&#59; &#8722;0&#46;017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DM2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;063 &#40;&#8722;0&#46;079&#59; &#8722;0&#46;047&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fracture in postmenopause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;030 &#40;&#8722;0&#46;043&#59; &#8722;0&#46;017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prevalence of vertebral fractures&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frailty fractures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;034 &#40;&#8722;0&#46;047&#59; &#8722;0&#46;022&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;019 &#40;&#8722;0&#46;030&#59; &#8722;0&#46;008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Simple and multiple linear regression analysis&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Osteoporosis prevention&#44; diagnosis and therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "NIH&#44; consensus development panel on osteoporosis prevention&#44; diagnosis&#44; therapy"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "2001"
                        "volumen" => "285"
                        "paginaInicial" => "785"
                        "paginaFinal" => "795"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "WHO Study Group on Assessment of fracture risk and its application to screening for postmenopausal osteoporosis&#58; report of a WHO study group &#91;meeting held in Rome from 22 to 25 June 1992&#93;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "1994"
                        "editorial" => "OMS&#46; Series de informes t&#233;cnicos 843&#46; Ginebra"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive value of BMD for hip and other fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Johnell"
                            1 => "J&#46;A&#46; Kanis"
                            2 => "A&#46; Oden"
                            3 => "H&#46; Johansson"
                            4 => "C&#46; De Laet"
                            5 => "P&#46; Delmas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1359/JBMR.050304"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2005"
                        "volumen" => "20"
                        "paginaInicial" => "1185"
                        "paginaFinal" => "1194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15940371"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "The effect of age and bone mineral density on the absolute&#44; excess&#44; and relative risk of fracture in posmenopausal women aged 50&#8211;99&#59; results from the National Osteoporosis Risk Assessment &#40;NORA&#41;"
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Original article
DOI: 10.1016/j.rceng.2017.12.002
Usefulness of the trabecular bone score for assessing the risk of osteoporotic fracture
Utilidad del Trabecular Bone Score en la valoración del riesgo de fractura osteoporótica
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L. Redondoa,e, E. Puigoriolb,e, J.R. Rodríguezc,e, P. Perisd, E. Kanterewiczc,e,
Corresponding author
ekanterewicz@chv.cat

Corresponding author.
a Servicio de Urgencias Consorci Hospitalari de Vic, Vic, Barcelona, Spain
b Unidad de Epidemiología Clínica, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
c Servicio de Reumatología, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
d Unidad de Metabolismo Óseo, Servicio de Reumatología, Hospital Clinic, Barcelona, Spain
e Grupo de investigación TR2LAB, Universitat de Vic, Universitat Central de Catalunya, Vic, Barcelona, Spain
Related content
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