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Spine Bone Texture Assessed by Trabecular Bone Score (TBS) to Evaluate Bone Health in Thalassemia Major

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Abstract

Due to the increasing survival of thalassemic patients, osteopathy is a mounting clinical problem. Low bone mass alone cannot account for the high fracture risk described; impaired bone quality has been speculated but so far it cannot be demonstrated noninvasively. We studied bone quality in thalassemia major using trabecular bone score (TBS), a novel texture measurement extracted from spine dual-energy X-ray absorptiometry (DXA), proposed in postmenopausal and secondary osteoporosis as an indirect index of microarchitecture. TBS was evaluated in 124 adult thalassemics (age range 19–56 years), followed-up with optimal transfusional and therapeutical regimens, and in 65 non-thalassemic patients (22–52 years) undergoing DXA for different bone diseases. TBS was lower in thalassemic patients (1.04 ± 0.12 [range 0.80–1.30]) versus controls (1.34 ± 0.11 [1.06–1.52]) (p < 0.001), and correlated with BMD. TBS and BMD values correlated with age, indicating that thalassemia negatively affects both bone quality and quantity, especially as the patient gets older. TBS was 1.02 ± 0.11 [0.80–1.28] in the osteoporotic thalassemic patients, 1.08 ± 0.12 [0.82–1.30] in the osteopenic ones and 1.15 ± 0.10 [0.96–1.26] in those with normal BMD. No gender differences were found (males: 1.02 ± 0.13 [0.80–1.30], females 1.05 ± 0.11 [0.80–1.30]), nor between patients with and without endocrine–metabolic disorders affecting bone metabolism. Our findings from a large population with thalassemia major show that TBS is a valuable tool to assess noninvasively bone quality, and it may be related to fragility fracture risk in thalassemic osteopathy.

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Conflict of Interest

Didier Hans is co-owner of the TBS patent and has corresponding ownership shares in Medimaps group. Marina Baldini, Fabio Massimo Ulivieri, Stella Forti, Serena Serafino, Sonia Seghezzi, Alessia Marcon, Federico Giarda, Carmelo Messina, Elena Cassinerio, Bérengère Aubry-Rozier, and Maria Domenica Cappellini declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (retrospective) formal consent is not required.

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Authors and Affiliations

  1. Rare Diseases Center, Department of Medicine and Medical Specialities, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    M. Baldini, A. Marcon, E. Cassinerio & M. D. Cappellini

  2. Bone Metabolic Unit, Department of Nuclear Medicine, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    F. M. Ulivieri

  3. Audiology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    S. Forti

  4. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    S. Serafino, S. Seghezzi, F. Giarda, C. Messina & M. D. Cappellini

  5. Center of Bone Diseases, Lausanne University Hospital (CHUV - DAL), Lausanne, Switzerland

    B. Aubry-Rozier & D. Hans

Authors
  1. M. Baldini
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  2. F. M. Ulivieri
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  3. S. Forti
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  4. S. Serafino
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  5. S. Seghezzi
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  6. A. Marcon
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  7. F. Giarda
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  8. C. Messina
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  9. E. Cassinerio
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  10. B. Aubry-Rozier
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  11. D. Hans
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  12. M. D. Cappellini
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Correspondence to M. Baldini.

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Baldini, M., Ulivieri, F.M., Forti, S. et al. Spine Bone Texture Assessed by Trabecular Bone Score (TBS) to Evaluate Bone Health in Thalassemia Major. Calcif Tissue Int 95, 540–546 (2014). https://doi.org/10.1007/s00223-014-9919-7

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  • DOI: https://doi.org/10.1007/s00223-014-9919-7

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