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Degraded microarchitecture by low trabecular bone score is associated with prevalent vertebral fractures in patients with systemic lupus erythematosus

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Abstract

Purpose

Recently, trabecular bone score (TBS) has emerged as an important supplementary assessment tool in osteoporosis diagnosis and management. The high incidence of fragility fracture within the non-osteoporotic range of bone mineral density (BMD), among systemic lupus erythematosus (SLE) patients, highlights the crucial role of bone microarchitecture in osteoporosis. This study aimed to evaluate whether TBS identified existing vertebral fractures (VF) more accurately than BMD in SLE patients.

Methods

This study enrolled 147 SLE patients from the Asia Pacific Lupus Collaboration (APLC) cohort, who had BMD and TBS assessed from January 2018 until December 2018. Twenty-eight patients sustaining VF and risk factors associated with increased fracture occurrence were evaluated. Independent risk factors and diagnostic accuracy of VF were analyzed by logistic regression and ROC curve, respectively.

Result

The prevalence of vertebral fracture among SLE patients was 19%. BMD, T-score, TBS, and TBS T-score were significantly lower in the vertebral fracture group. TBS exhibited higher positive predictive value and negative predictive value than L spine and left femur BMD for vertebral fractures. Moreover, TBS had a higher diagnostic accuracy than densitometric measurements (area under curve, 0.811 vs. 0.737 and 0.605).

Conclusion

Degraded microarchitecture by TBS was associated with prevalent vertebral fractures in SLE patients. Our result suggests that TBS can be a complementary tool for assessing vertebral fracture prevalence in this population.

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Acknowledgments

We would like to thank the Biostatistics Task Force of Taichung Veterans General Hospital for their assistance in performing the statistical analysis. The authors thank Brian Brown, NIH Library Writing Center, for manuscript editing assistance.

Funding

This study was supported by a grant from Taichung Veterans General Hospital, Taiwan (TCVGH-1087312C).

Author information

Author notes

  1. Yi-Ming Chen and Yi-Hsing Chen contributed equally to this work.

Authors and Affiliations

  1. Rheumatology Unit, Department of Internal Medicine, Hospital Sultan Ismail, Johor Bahru, Malaysia

    Ee-Ling Lai

  2. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung, 40705, Taiwan

    Ee-Ling Lai, Wen-Nan Huang, Hsin-Hua Chen, Tsu-Yi Hsieh, Wei-Ting Hung, Kuo-Lung Lai, Ching-Tsai Lin, Kuo-Tung Tang, Yi-Ming Chen & Yi-Hsing Chen

  3. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan

    Wen-Nan Huang, Hsin-Hua Chen, Yi-Ming Chen & Yi-Hsing Chen

  4. Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan

    Hsin-Hua Chen, Jun-Peng Chen & Yi-Ming Chen

  5. Rong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan

    Hsin-Hua Chen & Yi-Ming Chen

  6. Translational Medicine, National Chung Hsing University, Taichung, Taiwan

    Hsin-Hua Chen & Yi-Ming Chen

  7. Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan

    Hsin-Hua Chen

  8. Rheumatology and Immunology Center, Department of Medicine, China Medical University Hospital, Taichung, Taiwan

    Der-Yuan Chen

  9. College of Medicine, China Medical University, Taichung, Taiwan

    Der-Yuan Chen

  10. Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan

    Tsu-Yi Hsieh & Wei-Ting Hung

  11. Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, USA

    Yi-Ming Chen

Authors
  1. Ee-Ling Lai
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  12. Yi-Hsing Chen
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Corresponding author

Correspondence to Yi-Ming Chen.

Ethics declarations

This study was approved by the Ethics Committee of Clinical Research, Taichung Veterans General Hospital (CE17111A). As the patients’ data were anonymized before analysis, the requirement for written consent from patients was waived for this study.

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Lai, EL., Huang, WN., Chen, HH. et al. Degraded microarchitecture by low trabecular bone score is associated with prevalent vertebral fractures in patients with systemic lupus erythematosus. Arch Osteoporos 15, 54 (2020). https://doi.org/10.1007/s11657-020-00726-3

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