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"Pain. Joints. Spine." 1 (21) 2016

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Comparison of TBS and FRAX in fracture risk assessment of postmenopausal females with osteopenia

Authors: Kuzma M., Jackuliak P. - Medical Faculty of Comenius University, 5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia; Vanuga P. - National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia; Killinger Z., Payer J. - Medical Faculty of Comenius University, 5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia

Categories: Rheumatology, Traumatology and orthopedics

Sections: Medical forums

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The article was published on p. 76


Introduction. More than half of osteopenic patients suffer from fracture (Fx), but BMD osteopenia is usually not considered for treatment initiation. To our knowledge there is no study which compares risk stratifying methods in Fx prediction of BMD non-therapy group.

Objective. Comparison of three methods, trabecular bone score (TBS), FRAX and FRAX adjusted for TBS in Fx risk prediction of postmenopausal (PM) females.
Methods. Observational cohort study of PM females with BMD osteopenia (defined as T-score ≤ –1 ≥ –2,5) during 2/2009-5/2015 was performed. Patients underwent TBS, FRAX and FRAX adjusted for TBS evaluation. Using NOF cutoff values of 20 % for major osteoporotic Fx and 3 % for hip Fx were used to consider patients at high absolute 10 years risk of Fx. With redard to TBS patients were divided to 3 groups: normal, moderate and degraded. According to temporary consensus guidelines patients with BMD osteopenia + very low (degraded) TBS (< 1,1) are at high risk of developing Fx. TBS Insight® tool was used to assess TBS derived from L-spine DXA scans. Primary endpoint during follow-up was clinical Fx/death.
Results. In total, 144 PM females (mean age 66,1 yrs., BMI 26,7 kg/m2, T-score: neck —1,2; L-spine 1,4, TBS 1,24) were included. At baseline, 31,9 %; 30,5 and 34 % belonged to high Fx risk group according to TBS, FRAX and FRAX adjusted for TBS, respectively. Trend to increase Fx risk (RR 2,3; 95% CI 0,32; 12,5) was observed by degraded TBS. Fx/death probability was significantly 4,28-times higher in patients with degraded TBS value (RR 5,28, 95% CI 1,4; 19,1). Mean time to Fx/death was 4,4 yrs.
Conclusions. Patients with BMD osteopenia with degraded trabecular microarchitecture are at high risk of Fx. This study provides supportive results that TBS is appropriate method to assess high risk of Fx patients with BMD osteopenia.  

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