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Bone mineral density (BMD) and vertebral trabecular bone score (TBS) for the identification of elderly women at high risk for fracture: the SEMOF cohort study

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Abstract

Purpose

To determine the predictive value of the vertebral trabecular bone score (TBS) alone or in addition to bone mineral density (BMD) with regard to fracture risk.

Methods

Retrospective analysis of the relative contribution of BMD [measured at the femoral neck (FN), total hip (TH), and lumbar spine (LS)] and TBS with regard to the risk of incident clinical fractures in a representative cohort of elderly post-menopausal women previously participating in the Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk study.

Results

Complete datasets were available for 556 of 701 women (79 %). Mean age 76.1 years, LS BMD 0.863 g/cm2, and TBS 1.195. LS BMD and LS TBS were moderately correlated (r 2 = 0.25). After a mean of 2.7 ± 0.8 years of follow-up, the incidence of fragility fractures was 9.4 %. Age- and BMI-adjusted hazard ratios per standard deviation decrease (95 % confidence intervals) were 1.58 (1.16–2.16), 1.77 (1.31–2.39), and 1.59 (1.21–2.09) for LS, FN, and TH BMD, respectively, and 2.01 (1.54–2.63) for TBS. Whereas 58 and 60 % of fragility fractures occurred in women with BMD T score ≤−2.5 and a TBS <1.150, respectively, combining these two thresholds identified 77 % of all women with an osteoporotic fracture.

Conclusions

Lumbar spine TBS alone or in combination with BMD predicted incident clinical fracture risk in a representative population-based sample of elderly post-menopausal women.

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Acknowledgments

We are grateful to Philippe Kress, MD, for reviewing and commenting on our manuscript.

Conflict of interest

Didier Hans is co-owner of the TBS patent and has corresponding ownership shares. None of the other authors has any conflicts of interest.

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Authors and Affiliations

  1. Department of Osteoporosis, University Hospital and University of Bern, 3010, Bern, Switzerland

    Albrecht W. Popp, Salome Meer, Romain Perrelet & Kurt Lippuner

  2. Department of Musculoskeletal Medicine, Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland

    Marc-Antoine Krieg & Didier Hans

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  1. Albrecht W. Popp
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  2. Salome Meer
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  3. Marc-Antoine Krieg
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Correspondence to Kurt Lippuner.

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Popp, A.W., Meer, S., Krieg, MA. et al. Bone mineral density (BMD) and vertebral trabecular bone score (TBS) for the identification of elderly women at high risk for fracture: the SEMOF cohort study. Eur Spine J 25, 3432–3438 (2016). https://doi.org/10.1007/s00586-015-4035-6

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  • DOI: https://doi.org/10.1007/s00586-015-4035-6

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