Skip to main content

Advertisement

SpringerLink
Log in

Trabecular Bone Score in der Rheumatologie

Gibt es einen Nutzen im Vergleich zur alleinigen Osteodensitometrie?

Trabecular bone score in rheumatology

Are there benefits in comparison to bone densitometry alone?

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Patient*innen mit entzündlich rheumatischen Erkrankungen weisen aufgrund des Entzündungspotenzials ihrer Erkrankung, aber auch wegen der oft notwendigen Glukokortikoidbehandlung ein erhöhtes Frakturrisiko auf. Die Abschätzung des Frakturrisikos erfolgt nach aktueller DVO(Dachverband Osteologie)-Leitlinie auch mittels „dual-energy X‑ray absorptiometry“, diese kann auch durch die Bestimmung des Trabecular Bone Score (TBS) ergänzt werden. Die Erhebung von TBS bringt zusätzliche Vorteile z. B. bei der Glukokortikoid-induzierten Osteoporose, aber auch bei Patient*innen mit osteoproliferativen Veränderungen an der Wirbelsäule (Spondylarthritiden) und optimiert somit im rheumatologischen Patientengut die Frakturrisikoabschätzung.

Abstract

Patients with inflammatory rheumatic diseases have an increased risk of fractures due to the inflammatory potential of the disease and also because of the treatment with glucocorticoids that is often necessary. According to the current guidelines of the Governing Body on Osteology (DVO), the fracture risk can be assessed using dual energy X‑ray absorptiometry and can also be supplemented by measuring the trabecular bone score (TBS). The assessment of the TBS offers additional advantages, for example in glucocorticoid-induced osteoporosis and in patients with osteoproliferative changes of the spine (spondylarthritis) and thus optimizes the fracture risk assessment in the rheumatological patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Konnopka A, Jerusel N, König HH (2009) The health and economic consequences of osteopenia- and osteoporosis-attributable hip fractures in Germany: estimation for 2002 and projection until 2050. Osteoporos Int 20(7):1117–1129

    CAS  PubMed  Google Scholar 

  2. Rossini M, Viapiana O, Vitiello M, Malavolta N, La Montagna G, Maddali Bongi S et al (2017) Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study. Reumatismo 69(1):30–39

    CAS  PubMed  Google Scholar 

  3. Cetin B, Cetin EA, Arikan H, Velioglu A, Alibaz-Oner F, Direskeneli H et al (2021) FRAX scores are increased in patients with ANCA-associated vasculitis. Int Urol Nephrol 53(11):2333–2339

    CAS  PubMed  Google Scholar 

  4. Chen J, Lei L, Pan J, Zhao C (2020) A meta-analysis of fracture risk and bone mineral density in patients with systemic sclerosis. Clin Rheumatol 39(4):1181–1189

    PubMed  Google Scholar 

  5. Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W et al (2016) Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis 75(6):1016–1023

    CAS  PubMed  Google Scholar 

  6. Paskins Z, Whittle R, Sultan AA, Muller S, Blagojevic-Bucknall M, Helliwell T et al (2018) Risk of fracture among patients with polymyalgia rheumatica and giant cell arteritis: a population-based study. BMC Med 16(1):4

    PubMed  PubMed Central  Google Scholar 

  7. Wang X, Yan S, Liu C, Xu Y, Wan L, Wang Y et al (2016) Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Osteoporos Int 27(4):1413–1423

    CAS  PubMed  Google Scholar 

  8. Xue AL, Wu SY, Jiang L, Feng AM, Guo HF, Zhao P (2017) Bone fracture risk in patients with rheumatoid arthritis: a meta-analysis. Medicine (Baltimore) 96(36):e6983

    PubMed  Google Scholar 

  9. Dachverband der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaften (2017) Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern. https://dv-osteologie.org/uploads/Leitlinie%202017/Finale%20Version%20Leitlinie%20Osteoporose%202017_end.pdf. Zugegriffen: 19.2.2023

  10. World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group

    Google Scholar 

  11. Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ et al (2014) The clinical diagnosis of osteoporosis: a position statement from the national bone health alliance working group. Osteoporos Int 25(5):1439–1443

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Rosen H, Saag K (2022) Prevention and treatment of glucocorticoid-induced osteoporosis: UpToDate. https://www.uptodate.com/contents/prevention-and-treatment-of-glucocorticoid-induced-osteoporosis. Zugegriffen: 19.2.2023

  13. Bouxsein ML, Eastell R, Lui LY, Wu LA, de Papp AE, Grauer A et al (2019) Change in bone density and reduction in fracture risk: a meta-regression of published trials. J Bone Miner Res 34(4):632–642

    PubMed  Google Scholar 

  14. Black DM, Bauer DC, Vittinghoff E, Lui LY, Grauer A, Marin F et al (2020) Treatment-related changes in bone mineral density as a surrogate biomarker for fracture risk reduction: meta-regression analyses of individual patient data from multiple randomised controlled trials. Lancet Diabetes Endocrinol 8(8):672–682

    CAS  PubMed  Google Scholar 

  15. Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi ML, Cooper C et al (2015) Trabecular Bone Score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone 78:216–224

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Choi YJ, Chung YS, Suh CH, Jung JY, Kim HA (2017) Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore) 96(45):e8661

    PubMed  Google Scholar 

  17. Hans D, Stenova E, Lamy O (2017) The Trabecular Bone Score (TBS) complements DXA and the FRAX as a fracture risk assessment tool in routine clinical practice. Curr Osteoporos Rep 15(6):521–531

    PubMed  Google Scholar 

  18. Hans D, Goertzen AL, Krieg MA, Leslie WD (2011) Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the manitoba study. J Bone Miner Res 26(11):2762–2769

    PubMed  Google Scholar 

  19. McCloskey EV, Oden A, Harvey NC, Leslie WD, Hans D, Johansson H et al (2016) A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res 31(5):940–948

    PubMed  Google Scholar 

  20. Ruaro B, Casabella A, Paolino S, Alessandri E, Patane M, Gotelli E et al (2020) Trabecular bone score and bone quality in systemic lupus erythematosus patients. Front Med (Lausanne) 7:574842

    PubMed  Google Scholar 

  21. Kim D, Cho SK, Kim JY, Choi YY, Sung YK (2016) Association between trabecular bone score and risk factors for fractures in Korean female patients with rheumatoid arthritis. Mod Rheumatol 26(4):540–545

    CAS  PubMed  Google Scholar 

  22. Buehring B, Thomas J, Wittkamper T, Baraliakos X, Braun J (2020) Evaluation of the Trabecular Bone Score (TBS) in routine clinical care of patients with inflammatory rheumatic and non-inflammatory diseases: correlation with conventional bone mineral density measurement and prevalence of vertebral fractures. Z Rheumatol 79(10):1067–1074

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Senn C, Gunther B, Popp AW, Perrelet R, Hans D, Lippuner K (2014) Comparative effects of teriparatide and ibandronate on spine Bone Mineral Density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study. Osteoporos Int 25(7):1945–1951

    CAS  PubMed  Google Scholar 

  24. Saag KG, Agnusdei D, Hans D, Kohlmeier LA, Krohn KD, Leib ES et al (2016) Trabecular bone score in patients with chronic glucocorticoid therapy-induced osteoporosis treated with alendronate or teriparatide. Arthritis Rheumatol 68(9):2122–2128

    CAS  PubMed  Google Scholar 

  25. Di Gregorio S, Del Rio L, Rodriguez-Tolra J, Bonel E, Garcia M, Winzenrieth R (2015) Comparison between different bone treatments on areal Bone Mineral Density (aBMD) and bone microarchitectural texture as assessed by the Trabecular Bone Score (TBS). Bone 75:138–143

    PubMed  Google Scholar 

  26. Shin YH, Gong HS, Lee KJ, Baek GH (2019) Older Age and higher body mass index are associated with a more degraded trabecular bone score compared to bone mineral density. J Clin Densitom 22(2):266–271

    PubMed  Google Scholar 

  27. Kong SH, Hong N, Kim JW, Kim DY, Kim JH (2021) Application of the trabecular bone score in clinical practice. J Bone Metab 28(2):101–113

    PubMed  PubMed Central  Google Scholar 

  28. Langsetmo L, Vo TN, Ensrud KE, Taylor BC, Cawthon PM, Schwartz AV et al (2016) The association between trabecular bone score and lumbar spine volumetric BMD is attenuated among older men with high body mass index. J Bone Miner Res 31(10):1820–1826

    PubMed  Google Scholar 

  29. Shuhart CR, Yeap SS, Anderson PA, Jankowski LG, Lewiecki EM, Morse LR et al (2019) Executive summary of the 2019 ISCD position development conference on monitoring treatment, DXA cross-calibration and least significant change, spinal cord injury, peri-prosthetic and orthopedic bone health, transgender medicine, and pediatrics. J Clin Densitom 22(4):453–471

    PubMed  Google Scholar 

  30. Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD (2015) Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 2: trabecular bone score. J Clin Densitom 18(3):309–330

    PubMed  Google Scholar 

  31. Fuentes AV, Pineda MD, Venkata KCN (2018) Comprehension of top 200 prescribed drugs in the US as a resource for pharmacy teaching, training and practice. Pharmacy 6(2):43

    PubMed  PubMed Central  Google Scholar 

  32. Buckley L, Humphrey MB (2018) Glucocorticoid-induced osteoporosis. N Engl J Med 379(26):2547–2556

    PubMed  Google Scholar 

  33. Mirza F, Canalis E (2015) Management of endocrine disease: secondary osteoporosis: pathophysiology and management. Eur J Endocrinol 173(3):R131–R151

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C (2003) Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 48(11):3224–3229

    PubMed  Google Scholar 

  35. Ito M (2014) Glucocorticoid and bone. Structural variations in steroid-induced osteoporosis. Clin Calcium 24(9):1343–1350

    PubMed  Google Scholar 

  36. Reid IR, Heap SW (1990) Determinants of vertebral mineral density in patients receiving long-term glucocorticoid therapy. Arch Intern Med 150(12):2545–2548

    CAS  PubMed  Google Scholar 

  37. Xue Y, Baker AL, Nader S, Orlander P, Sanchez AJ, Kellam J et al (2018) Lumbar spine Trabecular Bone Score (TBS) reflects diminished bone quality in patients with diabetes mellitus and oral glucocorticoid therapy. J Clin Densitom 21(2):185–192

    PubMed  Google Scholar 

  38. Nahm FS (2022) Receiver operating characteristic curve: overview and practical use for clinicians. Korean J Anesthesiol 75(1):25–36

    PubMed  PubMed Central  Google Scholar 

  39. Paggiosi MA, Peel NF, Eastell R (2015) The impact of glucocorticoid therapy on trabecular bone score in older women. Osteoporos Int 26(6):1773–1780

    CAS  PubMed  Google Scholar 

  40. Florez H, Hernández-Rodríguez J, Muxi A, Carrasco JL, Prieto-González S, Cid MC et al (2020) Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis. Rheumatology 59(7):1574–1580

    CAS  PubMed  Google Scholar 

  41. Martineau P, Leslie WD, Johansson H, Harvey NC, McCloskey EV, Hans D et al (2018) In which patients does lumbar spine Trabecular Bone Score (TBS) have the largest effect? Bone 113:161–168

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Redondo L, Puigoriol E, Rodríguez JR, Peris P, Kanterewicz E (2018) Utilidad del Trabecular Bone Score en la valoración del riesgo de fractura osteoporótica. Rev Clin Esp 218(3):121–127

    CAS  PubMed  Google Scholar 

  43. Klingberg E, Lorentzon M, Mellstrom D, Geijer M, Gothlin J, Hilme E et al (2012) Osteoporosis in ankylosing spondylitis—Prevalence, risk factors and methods of assessment. Arthritis Res Ther 14(3):R108

    PubMed  PubMed Central  Google Scholar 

  44. Richards C, Hans D, Leslie WD (2020) Trabecular Bone Score (TBS) predicts fracture in ankylosing spondylitis: the manitoba BMD registry. J Clin Densitom 23(4):543–548

    PubMed  Google Scholar 

  45. Wildberger L, Boyadzhieva V, Hans D, Stoilov N, Rashkov R, Aubry-Rozier B (2017) Impact of lumbar syndesmophyte on bone health as assessed by bone density (BMD) and bone texture (TBS) in men with axial spondyloarthritis. Joint Bone Spine 84(4):463–466

    PubMed  Google Scholar 

  46. Boussoualim K, Amouzougan A, Pallot-Prades B, Denarie D, Collet P, Marotte H et al (2018) Evaluation of bone quality with trabecular bone score in active spondyloarthritis. Joint Bone Spine 85(6):727–731

    PubMed  Google Scholar 

  47. Kang KY, Goo HY, Park SH, Hong YS (2018) Trabecular bone score as an assessment tool to identify the risk of osteoporosis in axial spondyloarthritis: a case-control study. Rheumatology (Oxford) 57(3):462–469

    CAS  PubMed  Google Scholar 

  48. Zuchowski P, Dura M, Jeka D, Waszczak-Jeka M (2022) The applicability of trabecular bone score for osteoporosis diagnosis in ankylosing spondylitis. Rheumatol Int 42(5):839–846

    CAS  PubMed  Google Scholar 

  49. Kang KY, Chung MK, Kim HN, Hong YS, Ju JH, Park SH (2018) Severity of sacroiliitis and erythrocyte sedimentation rate are associated with a low trabecular bone score in young male patients with ankylosing spondylitis. J Rheumatol 45(3):349–356

    PubMed  Google Scholar 

  50. Nam SW, Sung YK, Kim D, Cho SK, Song Y, Choi YY et al (2021) The usefulness of trabecular bone score in patients with ankylosing spondylitis. Korean J Intern Med 36(5):1211–1220

    PubMed  Google Scholar 

  51. Kang KY, Kim IJ, Park SH, Hong YS (2018) Associations between trabecular bone score and vertebral fractures in patients with axial spondyloarthritis. Rheumatology (Oxford) 57(6):1033–1040

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Med. Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Zhivana Boyadzhieva, Andriko Palmowski, Frank Buttgereit & Paula Hoff

  2. Section for Biostatistics and Evidence-Based Research, The Parker Institute, University of Copenhagen, Kopenhagen, Dänemark

    Andriko Palmowski

  3. MVZ Endokrinologikum Berlin am Gendarmenmarkt, Berlin, Deutschland

    Paula Hoff

Authors
  1. Zhivana Boyadzhieva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andriko Palmowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank Buttgereit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paula Hoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhivana Boyadzhieva.

Ethics declarations

Interessenkonflikt

Z. Boyadzhieva, A. Palmowski, F. Buttgereit und P. Hoff geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

Paula Hoff, Berlin

Sarah Ohrndorf, Berlin

Zhivana Boyadzhieva und Andriko Palmowski haben gleichermaßen beigetragen und teilen sich die Erstautor*innenschaft.

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boyadzhieva, Z., Palmowski, A., Buttgereit, F. et al. Trabecular Bone Score in der Rheumatologie. Z Rheumatol 82, 672–677 (2023). https://doi.org/10.1007/s00393-023-01407-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-023-01407-5

Schlüsselwörter

Keywords

Search

Navigation