After this observation, TBS was derived from DXA images of lumbar vertebrae, and significant correlations between trabecular indices by μCT and TBS were confirmed (13, 14). eCollection 2020. Red bone marrow, where all the blood cells are made, fills the space between the trabecular pores. The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. Chinese expert consensus on the diagnosis of osteoporosis by imaging and bone mineral density. Article Google Scholar 3. Keywords: Trabecular bone score (TBS) is complementary to conventional BMD as a marker for bone quality in patients with glucocorticoid induced osteoporosis. This work was supported by the National Institutes of Health (Grants R01 DK32333 and R01 AR051376) and by the Brazilian National Council of Technological and Scientific Development (to B.C.S.). Get the latest public health information from CDC:, Get the latest research information from NIH:, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: Khosla S , Riggs BL , Atkinson EJ , et al. Trabecular bone score (TBS), a novel tool in the evaluation of osteoporosis is an indirect indicator of bone microarchitecture. Trabecular bone score may indicate chronic kidney disease-mineral and bone disorder (CKD-MBD) phenotypes in hemodialysis patients: a prospective observational study. Therefore, this cross‐sectional study investigated the association between TBS and severe periodontitis. TBS measurements were performed in the Bone Disease Unit at the University of Lausanne (Lausanne, Switzerland), using deidentified spine DXA files from scans obtained at CUMC. It was proposed to be easily used in everyday practice as a surrogate of bone strength. TBS, a measurement technology readily available by DXA, shows promise in the clinical assessment of trabecular microstructure in PHPT. Results on Trabecular Bone Score (TBS) in these patients are lacking. The correlation of TBS with HRpQCT indices, mechanical parameters, and DXA measurements was assessed by the Pearson correlation test. TBS and aBMD together better predicted the variability in these HRpQCT indices and whole bone stiffness than either one alone (Table 3). 2017 Jul-Sep;20(3):334-345. doi: 10.1016/j.jocd.2017.06.019. TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. The study was approved by the institutional review board of CUMC, and all subjects gave written informed consent. Trabecular bone score and transilial bone trabecular histomorphometry in type 1 diabetes and healthy controls. The mean value of the individual measurements for L1–L4 represents the lumbar spine TBS (unitless). It was developed to reflect bone microarchitecture. Sweden: T rabecular and cortical volumetric bone mineral density (BMD) have opposite association with coronary-artery calcium score (CACS), suggests a recent study in the journal JAMA Cardiology. Even though these studies did not involve patients with PHPT, our findings suggest that low TBS may be related with decreased bone stiffness, and consequently, fracture risk, also in PHPT. Khosla S , Melton LJ , Wermers RA , Crowson CS , O'Fallon W , Riggs B. Vignali E , Viccica G , Diacinti D , et al. Trabecular bone score (TBS) is a newly developed index for assessing trabecular bone quality and fracture risk. Endocrinol Metab Clin North Am. Serum total calcium (normal, 8.4–10.2 mg/dL) and albumin were measured using standard methods (Quest Diagnostics, Madison, New Jersey), and calcium values were corrected for albumin concentration <4 g/dL. Recently, the trabecular bone score (TBS) has been introduced as a novel tool for assessing bone microarchitecture. Trabecular Bone Score (TBS®) by Medimaps is a fracture risk predictor using DEXA as a source. At the radius, TBS explained 25% and 21% of the variance in Tb.N and Tb.Sp, respectively, with a slight increase in the degree of variance explained by the combination of TBS with L1–L4 aBMD compared with L1–L4 aBMD alone (Table 3). Barbara Campolina Silva, Stephanie Boutroy, Chiyuan Zhang, Donald Jay McMahon, Bin Zhou, Ji Wang, Julia Udesky, Serge Cremers, Marta Sarquis, Xiang-Dong Edward Guo, Didier Hans, John Paul Bilezikian, Trabecular Bone Score (TBS)—A Novel Method to Evaluate Bone Microarchitectural Texture in Patients With Primary Hyperparathyroidism, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 5, 1 May 2013, Pages 1963–1970, Stein EM , Silva BC , Boutroy S , et al. Wang R, Ward MM (2018) Epidemiology of axial spondyloarthritis: an update. The ability of TBS to estimate trabecular microarchitectural texture and predict fracture risk, along with its direct measurement from DXA images, led us to investigate its potential utility in evaluating the trabecular skeleton in PHPT. Likewise, a recent ex vivo study on 16 human vertebrae showed a positive relationship between TBS assessed in L3 and mechanically measured bone stiffness of the same vertebra (14). Several salient observations have emerged. Because DXA does not directly measure trabecular bone and HRpQCT is not widely available, we used trabecular bone score (TBS), a novel gray-level textural analysis applied to spine DXA images, to estimate indirectly trabecular microarchitecture. high-resolution peripheral quantitative computed tomography, standard deviation of trabecular separation. INTRODUCTION:Trabecular bone score (TBS) is a textural index that evaluates bone microarchitecture of the lumbar spine. 1. Using linear regression analysis, variations in HRpQCT measurements of volumetric density were better predicted by the combination of TBS and L1–L4 aBMD than by either one alone. Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. Intact PTH (normal, 14–66 pg/mL) was measured by immunoradiometric assay (Scantibodies Laboratory, Santee, California) in the Bone Marker Laboratory at CUMC. Therefore, despite being derived from standard DXA images, the information contained in TBS is independent and complementary to the information provided by BMD and the FRAX® tool. Rubin MR , Bilezikian JP , McMahon DJ , et al. Epub 2020 May 22. Curr Opin Rheumatol 30(2):137–143. 2018 Jul;30(4):412-419. doi: 10.1097/BOR.0000000000000504. Standard bone density measurement is used to calculate and classify a patient’s risk for experiencing fracture(s), as high, moderate or low risk. TBS has the major clinical advantage of being readily available from images of DXA, a test routinely performed in PHPT. . 2020 Oct;10(10):2066-2077. doi: 10.21037/qims-2020-16. It was developed to reflect bone microarchitecture. For example, two Dusceac said trabecular bone score correlated with lumbar spine BMD in hemodialysis patients (r=0.382; P = .001) and controls (r=0.36; P = .002) … For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Our aim was to assess TBS in children with inflammatory bowel diseases and to evaluate correlations with clinical, laboratory and densitometric variables. . . Twenty-two postmenopausal women with PHPT were recruited from Columbia University Medical Center (CUMC). TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Please enable it to take advantage of the complete set of features! In contrast, the trabecular bone score is a novel and widely available tool that uses gray-scale variograms of the spine image from dual-energy x-ray absorptiometry to assess trabecular quality. Although the lumbar spine and tibia are both load-bearing sites, they are subjected to different loading forces, which might explain this observation. Bone. TBS® performs a gray level analysis (textures) on the DEXA images to determine bone integrity. Site-matched spine TBS parameters were extracted from the DXA image using TBS iNsight software (version 1.9; medimaps, Geneva, Switzerland). The trabecular bone score (TBS) is a textural measurement derived from lumbar spine d ual-energy X-ray absorptiometry (DXA) images. Z–score of −2.0 or less was regarded as «low bone mineral density». It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. SEATTLE — Trabecular bone score (TBS) and HbA1c may be good predictors of incident fractures in patients with type 1 diabetes, although bone mineral density (BMD) may not be predictive, according to a new study presented at the American Society for Bone and Mineral Research (ASBMR) 2015 Annual Meeting. This meta-analysis showed that compared with controls, diabetic patients had a lower trabecular bone score (TBS) than non-diabetic individuals, suggesting that TBS can be a useful measurement for the assessment of fracture risk in diabetic patients. This finding is in contrast to high-resolution peripheral quantitative computed tomography (HRpQCT) results of abnormal trabecular microstructure and epidemiological evidence for increased overall fracture risk in PHPT. These deficits are associated with reduced whole bone and trabecular stiffness by finite element analysis (FEA) (7). The poor correlation between TBS and aBMD at the lumbar spine, despite the fact that both evaluate the same region of bone, implies that these measurements are at least partially independent of each other.  |  The result is expressed as a Trabecular Bone Score. Bilezikian JP , Brandi ML , Rubin M , Silverberg SJ. These more recent findings by HRpQCT and FEA are consistent with epidemiological evidence of increased fracture risk at both vertebral and nonvertebral sites in PHPT (8–11). The average creatinine clearance was normal at 77.7 mL/min per 1.73 m2. This was a cross-sectional study conducted in a referral center. Parisien M , Cosman F , Mellish RW , et al. Because previous studies have shown strong correlations between microarchitecture assessed by HRpQCT and histomorphometry or μCT at the same bony regions (25, 35), site-to-site differences are likely to contribute to the weak correlations observed by Cohen et al (34). TBS correlated with all indices of trabecular microarchitecture, except trabecular thickness, after adjustment for body weight. Cohen A , Dempster DW , Muller R , et al. Finally, Boutroy et al (21) showed that TBS predicts osteoporotic fracture as well as lumbar spine aBMD and that TBS helps to define a subset of nonosteoporotic women at high risk for fracture. Hawkins Carranza F, Guadalix Iglesias S, De Mingo Dominguez ML, Allo Miguel G, Arroba CM, Alvares BL, Martínez Diaz-Guerra G. Med Sci (Basel). TBS® performs a gray level analysis (textures) on the DEXA images to determine bone integrity. Methods . Because Tb.Sp and Tb.Sp.SD did not follow a normal distribution, they were log-transformed before analysis. Eight hundred and five Thai participants, aged 30 to 82 years, underwent bone quality assessment. Women were considered postmenopausal if they had not had a menstrual period for more than 1 year. Article Google Scholar 2. COVID-19 is an emerging, rapidly evolving situation. The discrepant observations by histomorphometric analysis of bone biopsy samples vis-à-vis fracture incidence in this disease suggest that HRpQCT and now TBS might be more clinically pertinent to fracture risk in PHPT. All statistical tests were performed at the 2-sided P < .05 significance level. The Trabecular Bone Score is a rather new index obtained at the lumbar spine at the same time as a real bone mineral density. Results from these studies have shown that a significantly greater number of postmenopausal women at high risk of fragility fracture are identified when a combination of either aBMD T-score ≤2.5 or TBS <1.200 is considered as opposed to aBMD T-score ≤2.5 alone (19, 22, 23). This measurement characterizes the mechanical competence of both cortical and trabecular compartments, and it is closely related to whole bone strength (28). Oxford University Press is a department of the University of Oxford. For each finite element model, a uniaxial compression test was performed with displacement equivalent to 1% apparent strain to calculate stiffness. To this end, our aim was to assess TBS from spine DXA images in postmenopausal women with PHPT and to correlate it, for the first time, with HRpQCT measurements of volumetric bone density, skeletal microarchitecture, and bone stiffness. Several salient observations have emerged. TBS is important because about one-half of people who break bones do not have a bone density that is classified as osteoporosis. Please enter the Trabecular Bone Score to compute the ten year probability of fracture adjusted for TBS. There are no studies assessing whether trabecular bone score characterizes bone quality in kidney transplant recipients. Noteworthy conclusions of this study of postmenopausal women with PHPT, therefore, are that TBS may help to identify structural abnormalities in trabecular bone and that conventional DXA assessment is insufficient for this purpose. The purpose of this study was to assess TBS from spine DXA images in relation to HRpQCT indices and bone stiffness in radius and tibia in PHPT. Search for other works by this author on: The study of hyperparathyroidism at the Massachusetts General Hospital, The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years, A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery, Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features, Skeletal disease in primary hyperparathyroidism, Effects on bone geometry, density, and microarchitecture in the distal radius but not the tibia in women with primary hyperparathyroidism: A case-control study using HR-pQCT, Primary hyperparathyroidism is associated with abnormal cortical and trabecular microstructure and reduced bone stiffness in postmenopausal women, Primary hyperparathyroidism and the risk of fracture: a population-based study, Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism, Increased mortality and morbidity in mild primary hyperparathyroid patients. The other authors have nothing to disclose. The present study sought to answer the specific question of whether patients with type 2 diabetes have a lower TBS than those without diabetes. Descriptive statistics are expressed as means ± SEM. The reference ranges in premenopausal women for OC, BSAP, and CTX were, respectively, 8.4 to 33.9 ng/mL, 11.6 to 29.6 U/L, and 0.112 to 0.738 ng/mL. Structure. However, part of this correlation was partially confounded with age. Liu XS , Zhang XH , Sekhon KK , et al. aBMD by DXA was measured at the lumbar spine (L1–L4), total hip, femoral neck, and nondominant forearm (ultradistal [UD] radius and one-third radius) using a Discovery A dual-energy X-ray absorptiometer (Hologic Inc; Bedford, Massachusetts). Yu N , Donnan PT , Flynn RW , Murphy MJ , Smith D , Rudman A , Leese GP. Trabecular bone score (TBS), a gray‐level texture measure derived from lumbar spine (LS) dual‐energy X‐ray absorptiometry (DXA) images, improves fracture risk prediction beyond that provided by the combination of bone mineral density (BMD) by DXA and clinical risk factors. Carter S, Lories RJ (2011) Osteoporosis: a paradox in ankylosing spondylitis. Serum intact amino-terminal propeptide of type I procollagen (Orion Diagnostica, Espoo, Finland) was measured by radioimmunoassay (normal, 19–83 μg/L). This site needs JavaScript to work properly. The results of this study show, for the first time, significant correlations between TBS and HRpQCT measurements of volumetric densities, skeletal microarchitecture, and bone stiffness at the radius and tibia in a group of postmenopausal women with PHPT. Trabecular bone score (TBS) is an indirect indicator of bone microarchitecture. The study was performed on healthy Iranian subjects who live in urban areas … TBS was correlated with whole bone stiffness and all HRpQCT indices, except for trabecular thickness and trabecular stiffness at the radius. Breban S , Briot K , Kolta S , et al. 2020 Dec 1;8(4):49. doi: 10.3390/medsci8040049. TBS was significantly correlated with tibia HRpQCT with regard to volumetric densities, Ct.Th, BV/TV, and whole bone stiffness. FRAX adjusted for TBS. Bone mineral density (BMD) was taken as a quantitative assessment and trabecular bone score (TBS) was used as qualitatively parameter.). The association between type 2 diabetes and trabecular bone score (TBS) has not been clear. Exclusion criteria included bisphosphonate or glucocorticoid use within the past 2 years, a history of Cushing syndrome, uncontrolled thyroid disease, malabsorption syndrome, significant liver disease, creatinine clearance <30 mL/min, and any chronic disorders of mineral metabolism such as Paget disease or osteogenesis imperfecta. . It is a textural index that evaluates pixel gray-level variations in the lumbar spine DXA (dual energy X-ray absorptiometry) image. 23 TBS is a bone texture parameter that quantifies cancellous bone microarchitecture, which is key in determining bone strength and resistance to fracture, by computing raw data from a dual energy X‐ray absorptiometry (DXA) image of the lumbar spine. Page 2 of 2 . Trabecular Bone Score . In the milder form of primary hyperparathyroidism (PHPT), cancellous bone, represented by areal bone mineral density at the lumbar spine by dual-energy x-ray absorptiometry (DXA), is preserved. TBS values are obtained from dual-energy X-ray absorptiometry (DXA) scans of the lumbar spine using a proprietary software program; TBS is a noninvasive, indirect measurement calculated from the projection of the three-dimensional bone structure onto a two-dimensional plane [ … With the use of linear regression analysis, TBS or L1–L4 aBMD alone explained 20 to 52% of variance in HRpQCT measurements of volumetric densities, Ct.Th, BV/TV, and whole bone stiffness at the radius and tibia. Parisien M , Mellish RW , Silverberg SJ , et al. . The pivotal TBS study showed significant relationships between TBS evaluated from 2D projection images directly derived from 3D μCT reconstruction and direct 3D measurements of trabecular microarchitecture by μCT (12). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Utility of trabecular bone score in the evaluation of osteoporosis. TBS (Trabecular Bone Score) iNsight est un paramètre de texture qui peut être appliqué aux images DXA, et qui quantifie les variations locales en niveau de gris. Leslie WD, Shevroja E, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Hans D. Osteoporos Int. This finding is not surprising, because cortical and trabecular compartments are both affected in PHPT, leading to strong correlations between measurements of trabecular and cortical microarchitecture and density, even among HRpQCT indices (eg, correlation between Tb.N and Ct.Th at the radius: r = 0.667; P = .001). The trabecular bone score (TBS) is a gray‐level textural metric that can be extracted from the two‐dimensional lumbar spine dual‐energy X‐ray absorptiometry (DXA) image. How does TBS benefit patients? In contrast to 72% of patients with PHPT showing degraded or partially degraded microarchitecture by TBS, only 46% were classified as osteopenic or osteoporotic by lumbar spine T-score. Because of the relatively small number of subjects, we could not evaluate any association between TBS and fracture risk in PHPT. The following indices were evaluated at the distal radius and tibia: total area and total vBMD, cortical vBMD (Ct.vBMD), and trabecular vBMD (Tb.vBMD); cortical thickness (Ct.Th); trabecular bone volume (BV/TV); trabecular number (Tb.N); trabecular thickness (Tb.Th); trabecular separation (Tb.Sp); and standard deviation of trabecular separation (Tb.Sp.SD), a parameter reflecting the heterogeneity of the trabecular network. TBS (Trabecular Bone Score) iNsight est un paramètre de texture qui peut être appliqué aux images DXA, et qui quantifie les variations locales en niveau de gris. . Med. In contrast, the trabecular bone score is a novel and widely available tool that uses gray-scale variograms of the spine image from dual-energy x-ray absorptiometry to assess trabecular quality. Krueger D., Fidler E., Libber J., Aubry-Rozier B, Hans D, Binkley N. Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women. The study was performed on healthy Iranian subjects who live in urban areas of Bushehr … Whereas HRpQCT has added a dimension of insight not previously seen with regard to trabecular bone in PHPT, HRpQCT is not widely available and remains so far a research tool.