RESUMO
Trabecular Bone Score (TBS) has proven its usefulness to improve areal Bone Mineral Density in diagnosing fracture risk and bone status evaluation. For it to be better interpreted, local reference values are recommended to account for population differences and, if possible, both in women and men, the former being scarcer. Using TBS, we reanalyzed data obtained from the Mexican population included in the Latin American Vertebral Osteoporosis Study and the Mexican Vertebral Study in men that included a random probability sample of 408 women and 414 men aged 50 and older without fractures. Data was used to obtain reference curves in such a population. Mean TBS in women ranged from an average of 1.359 ± 0.118 standard deviation (SD) 50 to 59 and decreased down to 1.211 ± 0.128 SD in women 80 and above. In men ranged from 1.382 ± 0.116 SD in the first group down to 1.315 ± 0.118 SD in the latter with little differences in age groups. Mean values in women are lower than previously suggested cutoff points to establish microarchitecture status using TBS: 1.350 and above normal, 1.200 to 1.349 partially degraded and 1.199 and below, degraded. Our TBS data have the strength of being a random sample drawn from the population, although limited in its extent to one city in Mexico. The means and curves may be used to diagnose bone status with better sensibility and specificity, although these values are yet to be evaluated.
Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Idoso , Densidade Óssea , Osso Esponjoso , Feminino , Humanos , Vértebras Lombares , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologiaRESUMO
Trabecular bone score (TBS) is a tool to improve evaluation of DXA scans, barely used in children. We proposed to evaluate TBS with bone age (BA) compared to chronological age (CA). In girls, TBS value using BA is constant until age 8, and in boys until age 10, and then starts to increase steadily. This data may help widen TBS use in pediatric populations. INTRODUCTION: Trabecular bone score (TBS) is a software-based tool for the analysis of DXA images to assess bone microarchitecture in the lumbar region. It is used widely in adults to improve evaluation of fracture risk, yet it has been rarely studied in children and no normal curves have been developed for pediatrics. The purpose of this study was to evaluate bone (skeletal) age compared to chronological age to determine which is better in the pediatric population since both bone age (BA) and trabecular density are equally susceptible to change in response to similar factors. METHODS: Total body, lumbar region, and non-dominant hand scans were obtained with an iDXA device in all participants. DXA scans of lumbar region for TBS analysis and AP images of non-dominant hand-for-BA were obtained for 565 children (269 female) aged 4to 19. RESULTS: Simple correlation was calculated and r2 values for TBS and chronological age were obtained by linear regression, with low correlations (0.36 for boys and 0.38 for girls), and then we created Loess curves to show the change for consecutive ages. In girls, the curve forms a U shape with a nadir point at approximately age 10. We then replaced chronological age with BA, and significant change was seen in the girls' curve, where a turning point is seen at age 8. In boys, a similar trend shows a turning point at age 10. Finally, BA-corrected TBS curves were constructed using LMS, obtaining curves with percentiles. CONCLUSIONS: The use of BA in the analysis and interpretation of TBS may help widen its use in pediatric populations by enabling the appearance of normative data, but more information is needed to confirm this finding.