FRAX adjustment by trabecular bone score with or without bone mineral density: the Manitoba BMD registry
FRAX adjustment by trabecular bone score with or without bone mineral density: the Manitoba BMD registry
Trabecular bone score (TBS), a texture measure derived from spine dual-energy x-ray absorptiometry (DXA) images, is a FRAX®-independent risk factor for fracture. The TBS adjustment to FRAX assumes the presence of femoral neck BMD in the calculation. However, there are many individuals in whom hip DXA cannot be acquired. Whether the TBS-adjustment would apply to FRAX probabilities calculated without BMD has not been studied. The current analysis was performed to evaluate major osteoporotic fracture (MOF) and hip fracture risk adjusted for FRAX with and without femoral neck BMD. The study cohort consisted of 71,209 individuals (89.8% female, mean age 64.0 years). During mean follow-up 8.7 years, 6743 (9.5%) individuals sustained one or more incident MOF, of which 2037 (2.9%) sustained a hip fracture. Lower TBS was significantly associated with increased fracture risk when adjusted for FRAX probabilities, with a slightly larger effect when BMD was not included. Inclusion of TBS in the risk calculation gave a small but significant increase in stratification for fracture probabilities estimated with and without BMD. Calibration plots showed very minor deviations from the line of identity, indicating overall good calibration. In conclusion, the existing equations for incorporating TBS in FRAX estimates of fracture probability work similarly when femoral neck BMD is not used in the calculation. This potentially extends the range of situations where TBS can be used clinically to those individuals in whom lumbar spine TBS is available but femoral neck BMD is not available.
Bone mineral density, Dual-energy x-ray absorptiometry, Fracture risk assessment, Osteoporosis, Trabecular bone score
Leslie, William D.
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Binkley, Neil
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McCloskey, Eugene V.
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Johansson, Helena
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Harvey, Nicholas C.
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Lorentzon, Mattias
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Kanis, John A.
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Hans, Didier
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1 July 2023
Leslie, William D.
5b2dd5d6-4569-40a3-a9b1-95152d11e4f1
Binkley, Neil
0e756aa9-b40c-44e6-97c4-65e28472d2bb
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Hans, Didier
1a5d8024-c245-4e99-afc6-b9b82d04cb22
Leslie, William D., Binkley, Neil, McCloskey, Eugene V., Johansson, Helena, Harvey, Nicholas C., Lorentzon, Mattias, Kanis, John A. and Hans, Didier
(2023)
FRAX adjustment by trabecular bone score with or without bone mineral density: the Manitoba BMD registry.
Journal of Clinical Densitometry, 26 (3), [101378].
(doi:10.1016/j.jocd.2023.101378).
Abstract
Trabecular bone score (TBS), a texture measure derived from spine dual-energy x-ray absorptiometry (DXA) images, is a FRAX®-independent risk factor for fracture. The TBS adjustment to FRAX assumes the presence of femoral neck BMD in the calculation. However, there are many individuals in whom hip DXA cannot be acquired. Whether the TBS-adjustment would apply to FRAX probabilities calculated without BMD has not been studied. The current analysis was performed to evaluate major osteoporotic fracture (MOF) and hip fracture risk adjusted for FRAX with and without femoral neck BMD. The study cohort consisted of 71,209 individuals (89.8% female, mean age 64.0 years). During mean follow-up 8.7 years, 6743 (9.5%) individuals sustained one or more incident MOF, of which 2037 (2.9%) sustained a hip fracture. Lower TBS was significantly associated with increased fracture risk when adjusted for FRAX probabilities, with a slightly larger effect when BMD was not included. Inclusion of TBS in the risk calculation gave a small but significant increase in stratification for fracture probabilities estimated with and without BMD. Calibration plots showed very minor deviations from the line of identity, indicating overall good calibration. In conclusion, the existing equations for incorporating TBS in FRAX estimates of fracture probability work similarly when femoral neck BMD is not used in the calculation. This potentially extends the range of situations where TBS can be used clinically to those individuals in whom lumbar spine TBS is available but femoral neck BMD is not available.
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More information
Accepted/In Press date: 24 April 2023
e-pub ahead of print date: 26 April 2023
Published date: 1 July 2023
Additional Information:
Funding Information:
Neil Binkley: Nothing to declare for the context of this paper; research funding from Radius; consultant Amgen.
Funding Information:
The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017- 29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.
Publisher Copyright:
© 2023 The International Society for Clinical Densitometry
Keywords:
Bone mineral density, Dual-energy x-ray absorptiometry, Fracture risk assessment, Osteoporosis, Trabecular bone score
Identifiers
Local EPrints ID: 480258
URI: http://eprints.soton.ac.uk/id/eprint/480258
ISSN: 1094-6950
PURE UUID: 14743772-f1ae-43bd-a056-c55e41655a0e
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Date deposited: 01 Aug 2023 17:13
Last modified: 17 Mar 2024 02:59
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Contributors
Author:
William D. Leslie
Author:
Neil Binkley
Author:
Eugene V. McCloskey
Author:
Helena Johansson
Author:
Mattias Lorentzon
Author:
John A. Kanis
Author:
Didier Hans
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