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Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry

Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry
Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry

Summary: Lumbar spine trabecular bone score (TBS) can be used to modify the output from the fracture risk assessment tool, FRAX, to enhance fracture prediction. An alternative approach for using TBS in clinical practice, based upon an adjustment to the bone mineral density (BMD) T-score, may be helpful in regions where intervention guidelines and/or reimbursement are primarily based on BMD T-score. Introduction: The aim of this study is to develop an approach for using TBS in clinical practice based upon a “risk-equivalent” adjustment to the BMD T-score. Methods: We identified 45,185 women age 40 years and older with baseline spine and hip DXA, TBS, and FRAX probabilities including femoral neck BMD. Incident major osteoporotic fractures (MOF, n = 3925) were identified from population-based health services data (mean follow-up 7.4 years comprising 335,910 person-years). Cox proportional hazards models adjusted for age and BMI were first used to estimate the risk for MOF from BMD T-score alone, then after including TBS and a multiplicative age interaction term. From the parameter estimates, we developed a TBS offset to the BMD T-score based upon change in TBS that would give the same risk as a unit change in BMD T-score for the femoral neck, total hip, and lumbar spine. Results: All BMD measurements, TBS, and the age interaction term independently predicted MOF (p OpenSPiltSPi 0.001). Measures of risk stratification and model fit were improved for the TBS-adjusted BMD T-score versus the unadjusted BMD T-score (p OpenSPiltSPi 0.001). There was a high level of agreement between MOF probability estimated from TBS-adjusted MOF FRAX probability and FRAX probability using the “risk-equivalent” femoral BMD T-score: MOF probability r2 = 0.98, slope = 1.02, intercept = − 0.3; hip probability r2 = 0.95, slope = 1.07, intercept = 0.0. Conclusions: The BMD-independent effect of lumbar spine TBS on fracture risk can be estimated as a simple offset to the BMD T-score.

Bone densitometry, DXA, Fracture prediction, Osteoporosis, Trabecular bone score
0937-941X
751-758
Leslie, W.D.
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Shevroja, E.
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Johansson, H.
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McCloskey, E.V.
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Harvey, N.C.
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Kanis, J.A,
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Hans, D.
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Leslie, W.D.
0c9bc973-969a-4049-aeb0-44a536074fb1
Shevroja, E.
2848486f-a840-4ec5-a468-e714f603e6e2
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, J.A,
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d
Hans, D.
1986bda6-590a-40af-8f44-825462b7305e

Leslie, W.D., Shevroja, E., Johansson, H., McCloskey, E.V., Harvey, N.C., Kanis, J.A, and Hans, D. (2018) Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry. Osteoporosis International, 29 (3), 751-758. (doi:10.1007/s00198-018-4405-0).

Record type: Article

Abstract

Summary: Lumbar spine trabecular bone score (TBS) can be used to modify the output from the fracture risk assessment tool, FRAX, to enhance fracture prediction. An alternative approach for using TBS in clinical practice, based upon an adjustment to the bone mineral density (BMD) T-score, may be helpful in regions where intervention guidelines and/or reimbursement are primarily based on BMD T-score. Introduction: The aim of this study is to develop an approach for using TBS in clinical practice based upon a “risk-equivalent” adjustment to the BMD T-score. Methods: We identified 45,185 women age 40 years and older with baseline spine and hip DXA, TBS, and FRAX probabilities including femoral neck BMD. Incident major osteoporotic fractures (MOF, n = 3925) were identified from population-based health services data (mean follow-up 7.4 years comprising 335,910 person-years). Cox proportional hazards models adjusted for age and BMI were first used to estimate the risk for MOF from BMD T-score alone, then after including TBS and a multiplicative age interaction term. From the parameter estimates, we developed a TBS offset to the BMD T-score based upon change in TBS that would give the same risk as a unit change in BMD T-score for the femoral neck, total hip, and lumbar spine. Results: All BMD measurements, TBS, and the age interaction term independently predicted MOF (p OpenSPiltSPi 0.001). Measures of risk stratification and model fit were improved for the TBS-adjusted BMD T-score versus the unadjusted BMD T-score (p OpenSPiltSPi 0.001). There was a high level of agreement between MOF probability estimated from TBS-adjusted MOF FRAX probability and FRAX probability using the “risk-equivalent” femoral BMD T-score: MOF probability r2 = 0.98, slope = 1.02, intercept = − 0.3; hip probability r2 = 0.95, slope = 1.07, intercept = 0.0. Conclusions: The BMD-independent effect of lumbar spine TBS on fracture risk can be estimated as a simple offset to the BMD T-score.

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Risk-equivalent Tscore TBS-v3-OSIN revised R1 - Accepted Manuscript
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Accepted/In Press date: 22 January 2018
e-pub ahead of print date: 1 February 2018
Published date: 1 March 2018
Keywords: Bone densitometry, DXA, Fracture prediction, Osteoporosis, Trabecular bone score

Identifiers

Local EPrints ID: 419068
URI: http://eprints.soton.ac.uk/id/eprint/419068
ISSN: 0937-941X
PURE UUID: ce3586ce-31c9-48bb-89aa-b2732997a358
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 28 Mar 2018 16:30
Last modified: 26 Nov 2021 06:19

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Contributors

Author: W.D. Leslie
Author: E. Shevroja
Author: H. Johansson
Author: E.V. McCloskey
Author: N.C. Harvey ORCID iD
Author: J.A, Kanis
Author: D. Hans

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