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FRAX adjustment by trabecular bone score with or without bone mineral density : The Manitoba BMD Registry
Leslie, William D. Binkley, Neil McCloskey, Eugene V. Johansson, Helena Harvey, Nicholas C. Lorentzon, Mattias Kanis, John A. Hans, Didier
Leslie, William D.
Binkley, Neil
McCloskey, Eugene V.
Johansson, Helena
Harvey, Nicholas C.
Lorentzon, Mattias
Kanis, John A.
Hans, Didier
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.
Keywords
osteoporosis, fracture risk assessment, dual-energy x-ray absorptiometry, trabecular bone score, bone mineral density
Date
2023
Type
Journal article
Journal
Journal of Clinical Densitometry
Book
Volume
26
Issue
3
Page Range
1-7
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Open
Notes
© 2023 The International Society for Clinical Densitometry. Published by Elsevier Inc.