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A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX
McCloskey, Eugene Oden, Anders Harvey, Nicholas C. Leslie, William Hans, D. Johansson, Helena Barkmann, Reinhard Boutroy, Stephanie Brown, J. P. Chapurlat, Roland D.
McCloskey, Eugene
Oden, Anders
Harvey, Nicholas C.
Leslie, William
Hans, D.
Johansson, Helena
Barkmann, Reinhard
Boutroy, Stephanie
Brown, J. P.
Chapurlat, Roland D.
Author
McCloskey, Eugene
Oden, Anders
Harvey, Nicholas C.
Leslie, William
Hans, D.
Johansson, Helena
Barkmann, Reinhard
Boutroy, Stephanie
Brown, J. P.
Chapurlat, Roland D.
Elders, Petra J. M.
Fujita, Yuki
Glüer, Claus C.
Goltzman, David
Iki, Masayuki
Karlsson, M. K.
Kindmark, Andreas
Kotowicz, Mark
Kurumatani, Norio
Kwok, Timothy
Lamy, Olivier
Leung, Jason
Lippuner, K.
Ljunggren, Östen
Lorentzon, Mattias
Mellström, Dan
Merlijn, Thomas
Oei, Ling
Ohlsson, C.
Pasco, Julie
Rivadeneira, A. Fernando
Rosengren, Björn E.
Sornay-Rendu, Elisabeth
Szulc, P.
Tamaki, Junko
Kanis, John A.
Oden, Anders
Harvey, Nicholas C.
Leslie, William
Hans, D.
Johansson, Helena
Barkmann, Reinhard
Boutroy, Stephanie
Brown, J. P.
Chapurlat, Roland D.
Elders, Petra J. M.
Fujita, Yuki
Glüer, Claus C.
Goltzman, David
Iki, Masayuki
Karlsson, M. K.
Kindmark, Andreas
Kotowicz, Mark
Kurumatani, Norio
Kwok, Timothy
Lamy, Olivier
Leung, Jason
Lippuner, K.
Ljunggren, Östen
Lorentzon, Mattias
Mellström, Dan
Merlijn, Thomas
Oei, Ling
Ohlsson, C.
Pasco, Julie
Rivadeneira, A. Fernando
Rosengren, Björn E.
Sornay-Rendu, Elisabeth
Szulc, P.
Tamaki, Junko
Kanis, John A.
Abstract
Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (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 1 SD 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% confidence interval [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 versus 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.
Keywords
trabecular bone structure, tbs, fracture, risk, frax, meta-analysis
Date
2016
Type
Journal article
Journal
Journal of Bone and Mineral Research
Book
Volume
31
Issue
5
Page Range
940-948
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
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Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled