Skip to main content

Advertisement

SpringerLink
Log in

Predictors of trabecular bone score in school children

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Trabecular bone score (TBS) is a DXA-based tool that assesses bone texture and reflects microarchitecture. It has been shown to independently predict the risk of osteoporotic fracture in the elderly. In this study, we investigated the determinants of TBS in adolescents.

Introduction

TBS is a gray-level textural measurement derived from lumbar spine DXA images. It appears to be an index of bone microarchitecture that provides skeletal information additional to the standard BMD measurement and clinical risk factors. Our objectives were to characterize the relationship between TBS and both age and pubertal stages and identify other predictors in adolescents.

Methods

We assessed TBS by reanalyzing spine DXA scan images obtained from 170 boys and 168 girls, age range 10–17 years, gathered at study entry and at 1 year, using TBS software. The results are from post hoc analyses obtained using data gathered from a prospective randomized vitamin D trial. Predictors of TBS were assessed using t test or Pearson’s correlation and adjusted using regression analyses, as applicable.

Results

The mean age of the study population was 13.2 ± 2.1 years, similar between boys and girls. Age, height, weight, sun exposure, spine BMC and BMD, body BMC and BMD, and lean and fat mass are all significantly correlated with TBS at baseline (r = 0.20–0.75, p < 0.035). Correlations mostly noted in late-pubertal stages. However, after adjustment for BMC, age remained an independent predictor only in girls.

Conclusions

In univariate exploratory analyses, age and pubertal stages were determinants of TBS in adolescents. Studies to investigate predictors of TBS and to investigate its value as a prognostic tool of bone fragility in the pediatric population are needed.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hansen MA, Overgaard K, Riis BJ, Christiansen C (1991) Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. BMJ 303:961–964

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Adler RA (ed) (2010) Osteoporosis: pathophysiology and clinical management. Humana Press, New York

    Google Scholar 

  3. Riis B, Hansen M, Jensen A, Overgaard K, Christiansen C (1996) Low bone mass and fast rate of bone loss at menopause: equal risk factors for future fracture: a 15-year follow-up study. Bone 19:9–12

    Article  CAS  PubMed  Google Scholar 

  4. Kilbanski A, Adams-Campbell L, Bassford T, Blair SN, Boden SD, Dickersin K, Gifford DR, Glasse L, Goldring SR, Hruska K (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA J Am Med Assoc 285:785

    Article  Google Scholar 

  5. Winzenberg T, Powell S, Shaw KA, Jones G (2011) Effects of vitamin D supplementation on bone density in healthy children: systematic review and meta-analysis. BMJ 342:7254

    Article  Google Scholar 

  6. El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, Choucair M, Arabi A, Vieth R (2006) Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab 91:405–412

    Article  PubMed  Google Scholar 

  7. Al-Shaar L, Nabulsi M, Maalouf J, El-Rassi R, Vieth R, Beck TJ, El-Hajj Fuleihan G (2013) Effect of vitamin D replacement on hip structural geometry in adolescents: a randomized controlled trial. Bone 56:296–303

    Article  CAS  PubMed  Google Scholar 

  8. 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 26:2762–2769

    Article  PubMed  Google Scholar 

  9. Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP (2014) Trabecular bone score: a non‐invasive analytical method based upon the DXA image. J Bone Miner Res 29:518–530

    Article  PubMed  Google Scholar 

  10. Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi M-L, Cooper C, Kendler D, Lamy O, Laslop A, Camargos BM, Reginster J-Y, Rizzoli R, Kanis JA (2015) Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone 78:216–224

    Article  CAS  PubMed  Google Scholar 

  11. Ulivieri FM, Silva BC, Sardanelli F, Hans D, Bilezikian JP, Caudarella R (2014) Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine 47:435–448

    Article  CAS  PubMed  Google Scholar 

  12. Cormier C (2012) TBS in routine clinical practice: proposals of use. Medimaps Group. www.medimapsgroup.com/upload/MEDIMAPS-UK-WEB.pdf. Accessed 20 Jan 2015

  13. Tanner J (1978) Physical growth and development. In: Forfar JO, Arneil G (eds) Textbook of paediatrics. Churchill Livingstone, Edinburgh, pp 249–303

    Google Scholar 

  14. El-Hajj Fuleihan G, Vieth R (2007) Vitamin D insufficiency and musculoskeletal health in children and adolescents. Int Congr Ser 1297:91–108

    Article  CAS  Google Scholar 

  15. Taylor A, Konrad PT, Norman ME, Harcke HT (1997) Total body bone mineral density in young children: influence of head bone mineral density. J Bone Miner Res 12:652–655

    Article  CAS  PubMed  Google Scholar 

  16. Gordon CM, Leonard MB, Zemel BS, International Society for Clinical D (2014) 2013 Pediatric Position Development Conference: executive summary and reflections. J Clin Densitom 17:219–224

    Article  PubMed  Google Scholar 

  17. Pothuaud L, Barthe N, Krieg M, Mehsen N, Carceller P, Hans D (2009) Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: a preliminary spine BMD–matched, case–control study. J Clin Densitom 12:170–176

    Article  PubMed  Google Scholar 

  18. Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305–1319

    Article  CAS  PubMed  Google Scholar 

  19. Del Rio L, Di Gregorio S, Winzenrieth R. (2014) Bone microarchitecture (TBS) and bone mass development during childhood and adolescence in a Spanish population group. ECCEO-IOF congress, Sevilla, Spain

  20. Leslie WD, Krieg MA, Hans D, Manitoba Bone Density Program (2013) Clinical factors associated with trabecular bone score. J Clin Densitom 16:374–379

    Article  PubMed  Google Scholar 

  21. Kolta S, Briot K, Fechtenbaum J, Paternotte S, Armbrecht G, Felsenberg D, Glüer C, Eastell R, Roux C (2014) TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int 25:1759–1764

    Article  CAS  PubMed  Google Scholar 

  22. Leib E, Winzenrieth R, Aubry-Rozier B, Hans D (2013) Vertebral microarchitecture and fragility fracture in men: a TBS study. Bone 62:51–55

    Article  PubMed  Google Scholar 

  23. El Hage R, Khairallah W, Bachour F, Issa M, Eid R, Fayad F, Yared C, Zakhem E, Adib G, Maalouf G (2013) Influence of age, morphological characteristics, and lumbar spine bone mineral density on lumbar spine trabecular bone score in Lebanese women. J Clin Densitom 17:434–435

    Article  PubMed  Google Scholar 

  24. Silva BC, Boutroy S, Zhang C, McMahon DJ, Zhou B, Wang J, Udesky J, Cremers S, Sarquis M, Guo XE (2013) Trabecular bone score (TBS)—a novel method to evaluate bone microarchitectural texture in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 98:1963–1970

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Senn C, Günther B, Popp A, 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 25:1945–1951

    Article  CAS  PubMed  Google Scholar 

  26. Krieg MA, Aubry-Rozier B, Hans D, Leslie WD, Manitoba Bone Density P (2013) Effects of anti-resorptive agents on trabecular bone score (TBS) in older women. Osteoporos Int 24:1073–1078

    Article  CAS  PubMed  Google Scholar 

  27. Dufour R, Winzenrieth R, Heraud A, Hans D, Mehsen N (2013) Generation and validation of a normative, age-specific reference curve for lumbar spine trabecular bone score (TBS) in French women. Osteoporos Int 24:2837–2846

    Article  CAS  PubMed  Google Scholar 

  28. Popp AW, Guler S, Lamy O, Senn C, Buffat H, Perrelet R, Hans D, Lippuner K (2013) Effects of zoledronate versus placebo on spine bone mineral density and microarchitecture assessed by the trabecular bone score in postmenopausal women with osteoporosis: a three-year study. J Bone Miner Res 28:449–454

    Article  CAS  PubMed  Google Scholar 

  29. Kalder M, Hans D, Kyvernitakis I, Lamy O, Bauer M, Hadji P (2013) Effects of exemestane and tamoxifen treatment on bone texture analysis assessed by tbs in comparison with bone mineral density assessed by DXA in women with breast cancer. J Clin Densitom 17:66–71

    Article  PubMed  Google Scholar 

  30. Rolighed L, Rejnmark L, Sikjaer T, Heickendorff L, Vestergaard P, Mosekilde L, Christiansen P (2013) Vitamin D treatment in primary hyperparathyroidism: a randomized placebo controlled trial. J Clin Endocrinol Metab 99:1072–1080

    Google Scholar 

Download references

Acknowledgments

The randomized controlled trial was supported in large part by an educational grant from Nestle Foundation and by a grant from Merck KGaA. Dr. Shawwa’s training was in part supported by the NIH Scholars in Health Research Program, a program made in part possible by an NIH award, 3D43TW009-118-03W1, PI Ghada El-Hajj Fuleihan. The authors thank the administrators, school nurses, parents, and students from the American Community School, the International College, Amlieh School and Ashbal Al Sahel School for their support in making the study possible, Mrs. S. Mroueh for her expert technical assistance in the acquisition and analyses of the bone mineral density scans and Mrs. C. Hajj Shahine for her tireless efforts in running the hormonal assays.

Conflict of interest

Khaled Shawwa, Asma Arabi, Mona Nabulsi, Joyce Maalouf, Mariana Salamoun, Mahmoud Choucair, and Ghada El-Hajj Fuleihan declare that they have no conflict of interest. Didier Hans is co-owner of the TBS patent and has corresponding ownership shares into medimaps group as well as chairman of the Board & part time CEO.

Author information

Authors and Affiliations

  1. Scholars in HeAlth Research Program, American University of Beirut, Beirut, Lebanon

    K. Shawwa & G. El-Hajj Fuleihan

  2. Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut-Medical Center, Bliss Street, 113-6044, Beirut, Lebanon

    K. Shawwa, A. Arabi, J. Maalouf, M. Salamoun & G. El-Hajj Fuleihan

  3. Division of Endocrinology, Department of Medicine, Beirut, Lebanon

    A. Arabi, J. Maalouf, M. Salamoun, M. Choucair & G. El-Hajj Fuleihan

  4. Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon

    M. Nabulsi

  5. Center of Bone Disease Bone and Joint Department, Lausanne University Hospital, Avenue Pierre Decker 4, 1011, Lausanne, VD, Switzerland

    D. Hans

Authors
  1. K. Shawwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Arabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Nabulsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Maalouf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Salamoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Choucair
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Hans
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. El-Hajj Fuleihan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. El-Hajj Fuleihan.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Appendix

(DOCX 45 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shawwa, K., Arabi, A., Nabulsi, M. et al. Predictors of trabecular bone score in school children. Osteoporos Int 27, 703–710 (2016). https://doi.org/10.1007/s00198-015-3255-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-015-3255-2

Keywords

Search

Navigation