Does Trabecular Bone Score (TBS) improve the predictive ability of FRAX® for major osteoporotic fractures according to the Japanese Population-Based Osteoporosis (JPOS) cohort study?
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This study examined whether bone microarchitecture determined by Trabecular Bone Score (TBS) is associated with the risk of major osteoporotic fractures independent of FRAX® in Japanese women. Participants included 1541 women aged ≥ 40 at baseline. Major osteoporotic fractures during a 10-year follow-up period were documented by the Japanese Population-based Osteoporosis Cohort Study. TBS and areal bone mineral density (aBMD) were calculated for the same spinal regions at baseline. To compare the predictive ability of FRAX® model when used alone versus in combination with TBS, Akaike information criterion (AIC), the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated. We identified 67 events of major osteoporotic fractures. The skeletal sites of the first fracture event were as follows: hip (11), vertebrae (13), radius (42), and humerus (1). The model incorporating FRAX® [1.35 (95% CI 1.09–1.67) for 1 standard deviation (SD) increase] with TBS [1.46 (95% CI 1.08–1.98) for 1 SD decrease] demonstrated better fit compared to a model consisting of FRAX alone (AIC 528.6 vs 532.7). NRI values for classification accuracy showed significant improvements in the FRAX® and TBS model, as compared to FRAX® alone [0.299 (95% CI 0.056-0.541)]. However, there were no significant differences in AUC or IDI between these models. The TBS score is associated with a risk of major osteoporotic fracture independent of FRAX® score obtained with or without BMD values among Japanese women during a 10-year follow-up period.
KeywordsTrabecular Bone Score (TBS) FRAX® Japanese women Prospective cohort study Major osteoporotic fracture
This study was conducted by the JPOS Study Group, consisting of Hideo Yoneshima (the head representative of the Study Group, ex-chairman of the Board of Directors, Medical Corporation Shuuwakai), Fumiaki Marumo (Chairman of the Study Group, Professor Emeritus, Tokyo Medical and Dental University), Toshihisa Matsuzaki (Co-Chairman of the Study Group, Institute of Comprehensive Community Care), Tomoharu Matsukura (Kanazawa University), Takashi Yamagami (Hokuriku Health Service Association), and Yoshiko Kagawa (the former president of Kagawa Nutrition University), along with the authors of this manuscript. Financial support for the baseline survey was provided by the Japan Milk Promotion Board and the Japan Dairy Council. Follow-up surveys were supported by Grants-in-Aid for Scientific Research (B #10470114, 1998–2000; B #14370147, 2002–2003; B #18390201, 2006-2008; C#18590619, 2006-9; B# 23390180, 2011-13; and C#23590824, 2011-13) from the Japanese Society for the Promotion of Science; a grant (2000–2002) from the Research Society for Metabolic Bone Diseases, Japan; and a Grand-in-Aid to study Milk Nutrition (2006) from the Japan Dairy Association. The authors wish to express special thanks to the personnel of the health departments of Miyako-jima City, Sanuki City, and Nishi-Aizu Town for their excellent support of the study. Finally, the authors would like to express their thanks to personnel from SRL, Tokyo, Japan; Toyo Medic, Osaka, Japan; and Toyukai Medical Corporation, Tokyo, Japan, for their technical assistance with the surveys.
Compliance with ethical standards
Conflict of interest
Renaud Winzenrieth was a senior scientist at Medimaps at the time of the study. Junko Tamaki, Masayuki Iki, Yuho Sato, Etsuko Kajita, Sadanobu Kagamimori declare that they have no conflict of interest.
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