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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

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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.

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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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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Railway Healthcare Center, Belgrade, Serbia

    Jelena Vasic & Filip Gojkovic

  2. Clinic of Rheumatology, Medical University, Sofia, Bulgaria

    Tzvetanka Petranova & Rasho Rashkov

  3. Department of Clinical Physiology and Pathology of Locomotor Apparatus, D.F. Chebotarev Institute of Gerontology NAMS Ukraine and Ukrainian Scientific-Medical Center for the Problems of Osteoporosis, Kiev, Ukraine

    Vladyslav Povoroznyuk & Nataliia Dzerovych

  4. Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Carmen Gabriela Barbu & Catalina Poiana

  5. Institute for Treatment and Rehabilitation “Niska Banja”, Nis, Serbia

    Mirjana Karadzic & Aleksandar Dimic

  6. Department of Internal Medicine, Railway Healthcare Center, Belgrade, Serbia

    Jelena Elez & Violeta CulaficVojinovic

  7. R&D Department, Med-Imaps, PTIB, Hopital Xavier Arnozan, Avenue du Haut-Lévêque, 33600, Pessac, France

    Renaud Winzenrieth

  8. Bone Diseases Center, DAL, Lausanne University Hospital, Lausanne, Switzerland

    Didier Hans

Authors
  1. Jelena Vasic
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  2. Tzvetanka Petranova
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  3. Vladyslav Povoroznyuk
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  4. Carmen Gabriela Barbu
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  5. Mirjana Karadzic
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  6. Filip Gojkovic
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  7. Jelena Elez
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  8. Renaud Winzenrieth
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  9. Didier Hans
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  10. Violeta CulaficVojinovic
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  11. Catalina Poiana
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  12. Nataliia Dzerovych
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  13. Rasho Rashkov
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  14. Aleksandar Dimic
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Corresponding author

Correspondence to Renaud Winzenrieth.

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Vasic, J., Petranova, T., Povoroznyuk, V. et al. 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. J Bone Miner Metab 32, 556–562 (2014). https://doi.org/10.1007/s00774-013-0529-7

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  • DOI: https://doi.org/10.1007/s00774-013-0529-7

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