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Bone Abstracts (2013) 1 PP58 | DOI: 10.1530/boneabs.1.PP58

ECTS2013 Poster Presentations Bone biomechanics and quality (28 abstracts)

Diagnostic discrimination of TBS and spine BMD in glucocorticoid-induced and postmenopausal osteoporosis

Margaret Paggiosi 1 , Nicola Peel 2 & Richard Eastell 1

1Mellanby Centre for Bone Research, University of Sheffield, Sheffield, South Yorkshire, UK; 2Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK.

Glucocorticoids inhibit osteoblast function and cause an increase in osteoblast and osteocyte apoptosis. Bone remodelling defects occur resulting in an increase in fracture risk that cannot be fully explained by decreases in bone mineral density (BMD). We propose that this may be due to alterations in bone quality. Trabecular bone score (TBS) correlates with 3D bone micro-architectural parameters and can be derived directly from grey-level variations within 2D DXA images.

We assessed the ability of BMD, TBS, and BMD with TBS (BMD+TBS) to discriminate between healthy women and i) glucocorticoid-treated women and ii) women with recent fractures.

Locally recruited older women (n=484, ages 55–79 years) had either i) taken prednisolone ≥5 mg/day (or equivalent) for >3 months (n=64, average dose range=5.0–20.0 mg/day) or ii) sustained a recent fracture of the distal forearm (n=46), proximal humerus (n=37), vertebra (n=30), or proximal femur (n=28). They were compared to healthy population-based women without prevalent fractures (n=279). Lumbar spine BMD was measured by DXA (Hologic QDR 4500A) and TBS values were derived following scan image reanalysis using TBS – Clinical Data Analysis software v1.6 (Med-Imaps).

BMD+TBS values were calculated using logistic regression analysis. The discriminatory ability; area under the curve (AUC); of BMD, TBS and BMD+TBS for prevalent fracture or glucocorticoid use was determined using receiver operator characteristic (ROC) analysis. The AUCs for i) BMD and TBS; ii) BMD and BMD+TBS; and iii) TBS and BMD+TBS were compared using pairwise comparisons of ROC curves (P<0.05).

Table 1 Discriminatory ability of BMD, TBS, and BMD+TBS for prevalent fracture or glucocorticoid use.
Study groupAUC95% CIAUC95% CIAUC95% CI
Forearm fracture0.641*0.547–0.7350.621*0.535–0.7070.622*0.575–0.749
Humerus fracture0.689*0.602–0.7760.757*0.679–0.8340.753*0.676–0.830
Vertebral fracture0.876*0.818–0.9350.802*0.725–0.8790.892*,c0.834–0.950
Hip fractures0.739*0.643–0.8340.696*0.594–0.7980.763*0.675–0.852
*AUC different from 0.5 (P<0.05).
aAUC differs between BMD and TBS (P=0.002).
bAUC differs between BMD and BMD+TBS (P=0.002).
cAUC differs between TBS and BMD+TBS (P=0.002).

Volume 1

European Calcified Tissue Society Congress 2013

Lisbon, Portugal
18 May 2013 - 22 May 2013

European Calcified Tissue Society 

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