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A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX

A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX
A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX
Trabecular bone score (TBS) is a grey-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a BMD-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables and outcomes during follow up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% CI: 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p?>?0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR 1.32, 95%CI: 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95%CI: 1.65, 1.87 vs. 1.70, 95%CI: 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. This article is protected by copyright. All rights reserved.
trabecular bone structure, tbs, fracture, risk, frax, meta-analysis
0884-0431
1-9
McCloskey, Eugene V.
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Harvey, Nicholas C.
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Szulc, Pawel
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Tamaki, Junko
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McCloskey, Eugene V., Odén, Anders, Harvey, Nicholas C., Leslie, William D., Hans, Didier, Johansson, Helena, Barkmann, Reinhard, Boutroy, Stephanie, Brown, Jacques, Chapurlat, Roland, Elders, Petra J.M., Fujita, Yuki, Glüer, Claus-C., Goltzman, David, Iki, Masayuki, Karlsson, Magnus, Kindmark, Andreas, Kotowicz, Mark, Kurumatani, Norio, Kwok, Timothy, Lamy, Oliver, Leung, Jason, Lippuner, Kurt, Ljunggren, Östen, Lorentzon, Mattias, Mellström, Dan, Merlijn, Thomas, Oei, Ling, Ohlsson, Claes, Pasco, Julie A., Rivadeneira, Fernando, Rosengren, Björn, Sornay-Rendu, Elisabeth, Szulc, Pawel, Tamaki, Junko and Kanis, John A. (2015) A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. Journal of Bone and Mineral Research, 1-9. (doi:10.1002/jbmr.2734). (PMID:26498132)

Record type: Article

Abstract

Trabecular bone score (TBS) is a grey-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a BMD-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables and outcomes during follow up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% CI: 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p?>?0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR 1.32, 95%CI: 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95%CI: 1.65, 1.87 vs. 1.70, 95%CI: 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. This article is protected by copyright. All rights reserved.

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Accepted/In Press date: 23 October 2015
e-pub ahead of print date: 19 November 2015
Keywords: trabecular bone structure, tbs, fracture, risk, frax, meta-analysis
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 386859
URI: http://eprints.soton.ac.uk/id/eprint/386859
ISSN: 0884-0431
PURE UUID: 6349ce3e-1d16-4188-b185-6915182f34eb
ORCID for Nicholas C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 04 Feb 2016 16:50
Last modified: 17 Dec 2019 01:48

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Contributors

Author: Eugene V. McCloskey
Author: Anders Odén
Author: William D. Leslie
Author: Didier Hans
Author: Helena Johansson
Author: Reinhard Barkmann
Author: Stephanie Boutroy
Author: Jacques Brown
Author: Roland Chapurlat
Author: Petra J.M. Elders
Author: Yuki Fujita
Author: Claus-C. Glüer
Author: David Goltzman
Author: Masayuki Iki
Author: Magnus Karlsson
Author: Andreas Kindmark
Author: Mark Kotowicz
Author: Norio Kurumatani
Author: Timothy Kwok
Author: Oliver Lamy
Author: Jason Leung
Author: Kurt Lippuner
Author: Östen Ljunggren
Author: Mattias Lorentzon
Author: Dan Mellström
Author: Thomas Merlijn
Author: Ling Oei
Author: Claes Ohlsson
Author: Julie A. Pasco
Author: Fernando Rivadeneira
Author: Björn Rosengren
Author: Elisabeth Sornay-Rendu
Author: Pawel Szulc
Author: Junko Tamaki
Author: John A. Kanis

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