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Journal of Bone and Mineral Metabolism

, Volume 32, Issue 5, pp 556–562 | Cite as

Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: the Eastern European TBS study

  • Jelena Vasic
  • Tzvetanka Petranova
  • Vladyslav Povoroznyuk
  • Carmen Gabriela Barbu
  • Mirjana Karadzic
  • Filip Gojkovic
  • Jelena Elez
  • Renaud WinzenriethEmail author
  • Didier Hans
  • Violeta CulaficVojinovic
  • Catalina Poiana
  • Nataliia Dzerovych
  • Rasho Rashkov
  • Aleksandar Dimic
Original Article

Abstract

The aim of the study was to assess the clinical performance of the model combining areal bone mineral density (aBMD) at spine and microarchitecural texture (TBS) for the detection of the osteoporotic fracture. The Eastern European Study is a multicenter study (Serbia, Bulgaria, Romania and Ukraine) evaluating the role of TBS in routine clinical practice as a complement to aBMD. All scans were acquired on Hologic Discovery and GE Prodigy densitometers in a routine clinical manner. The additional clinical values of aBMD and TBS were analyzed using a two steps classification tree approach (aBMD followed by TBS tertiles) for all type of osteoporotic fracture (All-OP Fx). Sensitivity, specificity and accuracy of fracture detection as well as the Net Reclassification Index (NRI) were calculated. This study involves 1031 women subjects aged 45 and older recruited in east European countries. Clinical centers were cross-calibrated in terms of BMD and TBS. As expected, areal BMD (aBMD) at spine and TBS were only moderately correlated (r 2 = 0.19). Prevalence rate for All-OP Fx was 26 %. Subjects with fracture have significant lower TBS and aBMD than subjects without fracture (p < 0.01). TBS remains associated with the fracture even after adjustment for age and aBMD with an OR of 1.27 [1.07–1.51]. When using aBMD T-score of −2.5 and the lowest TBS tertile thresholds, both BMD and TBS were similar in terms of sensitivity (35 vs. 39 %), specificity (78 vs. 80 %) and accuracy (64 vs. 66 %). aBMD and TBS combination, induced a significant improvement in sensitivity (+28 %) and accuracy (+17 %) compared to aBMD alone whereas a moderate improvement was observed in terms of specificity (+9 %). The overall combination gain was 36 % as expressed using the NRI. aBMD and TBS combination decrease significantly the number of subjects needed to diagnose from 7 for aBMD alone to 2. In a multi-centre Eastern European cohort, we have shown that the use of TBS in addition to the aBMD permit to reclassified correctly more than one-third of the overall subjects. Furthermore, the number of subjects needed to diagnose fell to 2 subjects. Economical studies have to be performed to evaluate the gain induced by the use of TBS for the healthcare system.

Keywords

Osteoporotic fracture Bone mineral density Trabecular bone score (TBS) Bone microarchitecture 

Notes

Conflict of interest

R. Winzenrieth is a senior scientist at Med-Imaps, Didier Hans is co-owner of the TBS patent and has corresponding ownership share in Medimaps group. All the others did not have any conflicts of interest.

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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2013

Authors and Affiliations

  • Jelena Vasic
    • 1
  • Tzvetanka Petranova
    • 2
  • Vladyslav Povoroznyuk
    • 3
  • Carmen Gabriela Barbu
    • 4
  • Mirjana Karadzic
    • 5
  • Filip Gojkovic
    • 1
  • Jelena Elez
    • 6
  • Renaud Winzenrieth
    • 7
    Email author
  • Didier Hans
    • 8
  • Violeta CulaficVojinovic
    • 6
  • Catalina Poiana
    • 4
  • Nataliia Dzerovych
    • 3
  • Rasho Rashkov
    • 2
  • Aleksandar Dimic
    • 5
  1. 1.Department of Physical Medicine and RehabilitationRailway Healthcare CenterBelgradeSerbia
  2. 2.Clinic of RheumatologyMedical UniversitySofiaBulgaria
  3. 3.Department of Clinical Physiology and Pathology of Locomotor ApparatusD.F. Chebotarev Institute of Gerontology NAMS Ukraine and Ukrainian Scientific-Medical Center for the Problems of OsteoporosisKievUkraine
  4. 4.Department of EndocrinologyCarol Davila University of Medicine and PharmacyBucharestRomania
  5. 5.Institute for Treatment and Rehabilitation “Niska Banja”NisSerbia
  6. 6.Department of Internal MedicineRailway Healthcare CenterBelgradeSerbia
  7. 7.R&D DepartmentMed-Imaps, PTIB, Hopital Xavier ArnozanPessacFrance
  8. 8.Bone Diseases Center, DALLausanne University HospitalLausanneSwitzerland

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