A Meta‐Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX |
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| Authors: | Eugene V McCloskey Anders Odén Nicholas C Harvey William D Leslie Didier Hans Helena Johansson Reinhard Barkmann Stephanie Boutroy Jacques Brown Roland Chapurlat Petra JM Elders Yuki Fujita Claus‐C Glüer David Goltzman Masayuki Iki Magnus Karlsson Andreas Kindmark Mark Kotowicz Norio Kurumatani Timothy Kwok Oliver Lamy Jason Leung Kurt Lippuner Östen Ljunggren Mattias Lorentzon Dan Mellström Thomas Merlijn Ling Oei Claes Ohlsson Julie A Pasco Fernando Rivadeneira Björn Rosengren Elisabeth Sornay‐Rendu Pawel Szulc Junko Tamaki John A Kanis |
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| Affiliation: | 1. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK;2. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK;3. University of Manitoba, Winnipeg, Canada;4. Lausanne University Hospital, Center of Bone Diseases, Lausanne, Switzerland;5. Sektion Biomedizinische Bildgebung Klinik für Diagnostische Radiologie, Kiel, Germany;6. INSERM UMR 1033 and Lyon University, E Herriot Hospital (HEH), Lyon, France;7. Department of Rheumatology, Laval University, Québec, Canada;8. Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands;9. Department of Public Health, Kinki University Faculty of Medicine, Osaka, Japan;10. Department of Medicine, McGill University Health Centre and McGill University, Montreal, Canada;11. Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Malm?, and Department of Orthopaedics, Sk?ne University Hospital, Malm?, Sweden;12. Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden;13. Epi‐Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia;14. Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara, Japan;15. Jockey Club Centre for Osteoporosis Care and Control, the Chinese University of Hong Kong, Hong‐Kong, China;16. Department of Osteoporosis, Inselspital, Berne University Hospital, Bern, Switzerland;17. Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenberg, Sweden;18. Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden;19. Department of Internal Medicine and Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands;20. Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan |
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| 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. © 2015 American Society for Bone and Mineral Research. |
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| Keywords: | TRABECULAR BONE STRUCTURE TBS FRACTURE RISK FRAX META‐ANALYSIS |
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