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Bone age as a correction factor for the analysis of trabecular bone score (TBS) in children

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Abstract

Summary

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.

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Acknowledgements

We thank MSc. Regina Ambrosi for her work in the acquisition of DXA scans.

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Authors and Affiliations

  1. Clinical Epidemiology Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico

    Miguel Angel Guagnelli, Desiree Lopez-Gonzalez & Patricia Clark

  2. R&D Department, Med-Imaps, Pessac, France

    Renaud Winzenrieth

  3. Oregon Osteoporosis Center, Portland, OR, USA

    Michael R. McClung

  4. AustralianCatholicUniversity, Melbourne, Australia

    Michael R. McClung

  5. CETIR Medical Centre, Barcelona, Spain

    Luis Del Rio

  6. Facultad de Medicina, UNAM, Mexico City, Mexico

    Patricia Clark

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  1. Miguel Angel Guagnelli
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  2. Renaud Winzenrieth
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  3. Desiree Lopez-Gonzalez
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  4. Michael R. McClung
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  5. Luis Del Rio
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Correspondence to Patricia Clark.

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The bioethics, biosafety, and scientific committees from Hospital Infantil Federico Gómez approved the protocol of this study.

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Guagnelli, M.A., Winzenrieth, R., Lopez-Gonzalez, D. et al. Bone age as a correction factor for the analysis of trabecular bone score (TBS) in children. Arch Osteoporos 14, 26 (2019). https://doi.org/10.1007/s11657-019-0573-6

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