GERONTOLOGIJA
Gerontologija 2014; 15(1): 7–12
Original article
Trabecular bone score, bone mineral density and 10-year fracture
probability in Ukrainian men of different ages
Vladyslav Povoroznyuk1, Anna Musiienko1, Nataliya Dzerovych1, Didier Hans2
Institute of Gerontology NAMS Ukraine, Ukrainian Scientific-Medical Centre for the Problems of Osteoporosis, Kyiv, Ukraine
Center of Bone diseases, Lausanne University Hospital, Lausanne, Switzerland
1 2 Abstract
Objective. To evaluate the bone mineral density (BMD),
trabecular bone score (TBS) and the 10-year probability of
major osteoporotic fractures and hip fractures in the healthy
men of different ages.
Materials and methods. We’ve examined 300 men aged
40–89 years (mean age – 60.9 ± 0.6 yrs; mean height –
1.74 ± 0.04 m; mean weight – 84.1 ± 0.9 kg), who were divided into groups depending on their age: 40–49 yrs (n = 52),
50–59 yrs (n = 86), 60–69 yrs (n = 89), 70–79 yrs (n = 59),
80–89 yrs (n = 14). The 10-year probability of hip fracture and
the 10-year probability of major osteoporotic fracture risk were
calculated by the Austrian, Polish and Russian FRAX® models.
BMD of the whole body, PA lumbar spine and proximal femur
were measured using the DXA method (Prodigy, GEHC Lunar,
Madison, WI, USA) and PA spine TBS were assessed by the
TBS iNsight® software package installed on the available DXA
machine (Med-Imaps, Pessac, France).
Address:Vladyslav Povoroznyuk
Vyshgorodskaya str. 67,
Kyiv, 04108 Ukraine
E-mail: [email protected]
Results. The age significantly influenced the BMD of lumbar
spine (F = 2.84, р = 0.02) and femoral neck (F = 4.08, р = 0.003)
in all the examined patients. A significantly decreased TBS (L1–
L4) was determined in men according to their ages (40–49 yrs –
1.116 ± 0.02, 50–59 yrs – 1.111 ± 0.02; 60–69 yrs – 1.118 ± 0.02;
70–79 yrs – 1.062 ± 0.02; 80–89 yrs – 1.080 ± 0.05; F = 2.42,
р = 0.048).We have observed a significant increase of a 10-year
probability of major osteoporotic fractures in the men aged
80–89 yrs (р < 0.01) using the Russian FRAX® model, 60–89 yrs
(р < 0.01) – Austrian FRAX® model, 70–89 yrs (р < 0.01) – Polish FRAX® model in comparison with the men aged 40–49 yrs.
The 10-year probability of hip fractures significantly increased in
the men aged 70–89 yrs in comparison with those aged 40–69 yrs
(р < 0.01).TBS was significantly higher in men with normal
BMD (1.121 ± 0.01), compared with the patients who have been
diagnosed with an osteoporosis – 1.066 ± 0.03 (р = 0.04). The
significant correlation was observed between TBS and BMD
L1–L4 in the examined men (r = 0.12; p = 0.03). No correlation
was found between TBS and BMD of femoral neck.
Conclusions. The TBS significantly decreased with ageing.
Subjects with osteoporosis have significantly lower TBS data
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V. Povoroznyuk, A. Musiienko, N. Dzerovych, D. Hans
compared with the examined patients with a normal BMD. A
significant correlation was found between the TBS and BMD of
lumbar spine. The 10-year probability of a major osteoporotic
fracture and hip fracture significantly increased in men with
age. The trabecular bone score is an independent parameter for
evaluation of the structural-functional bone state. We can use
the TBS in combination with FRAX and BMD for the improved
diagnosis of bone and joint diseases.
Key words:
trabecular bone score, bone mineral density, fractures
Introduction
There is a growing recognition of the fact that osteoporosis and fractures in older men are significant public health problems contributing towards disability and premature
death. Osteoporosis is defined as a systemic bone disease
characterized by a low bone mass and mircoarchitectural
deterioration of bone tissue, with a subsequent increase of
bone fragility and susceptibility to fracture. Osteoporosis
affects women more frequently than men for several reasons. Men accumulate more bone mass during the peak
growth years, making the adult male skeleton generally
stronger. They also accumulate more muscle mass during
puberty, which contributes to their skeletal strength. Male
hormone production does not cease abruptly, testosterone
level declines slowly throughout their life.
Men have osteoporotic fractures about 10 years later
in life than women. A third of all fractures affecting men is
femoral fractures [1], mortality caused by these fractures
37.5% higher than in women [2]. About 40% fractures of
this localization occur at home, 20% of men with a fractured femur in anamnesis after some time might re-fracture. Almost half of femoral fractures are registered before
80 [3]. However, vertebral fractures equal the respective
percentage of women’s.
At present, a special attention in the diagnosis of male
osteoporosis is paid to the risk factors. A combination of
several factors in one patient increases the risk of osteoporosis and fractures.
Diagnostic criteria of male osteoporosis are controversial. The gold standard to assess the Bone mineral density
(BMD) is considered to be a dual X-ray absorptiometry
(DXA), but this method does not assess microarchitecture alterations. According to the recommendations by the
International Society for Clinical Densitometry (2013),
BMD determination must be conducted in men over 70
years. The measurement of BMD for men aged 70 years
and over is performed if they have risk factors for a reduced
bone mass, such as low-energy fractures in their history,
chronic diseases and drugs affecting the bone metabolism.
BMD evaluation BMD of men aged 50 years and older was
conducted using the T-score; in the younger men using the
Z-score. If the T-score is between –1.0 and –2.5 standard
deviations (SD), we diagnose a low bone mineral density – osteopenia, less than –2.5 SD – osteoporosis. If the
patients have low-energy fractures in their history, osteoporosis is diagnosed. Today there is no accurate data on
the relationship of BMD and fracture risk, and whether
men and women with the same values of BMD have the
same risk factors [5].
BMD is a major but not unique predictor of the fracture risk. Some fractures occur in case of osteopenia or
normal BMD. This indicates the need for other diagnostic
criteria to identify the risk of fractures.
By the end of 2008, the experts of World Health Organization Metabolic Bone Disease Group developed their
FRAX® algorithm. FRAX® (a Fracture Risk Assessment
tool) has been developed for the prediction of a 10-year
probability of hip fracture and 10-year probability of a
major osteoporotic fracture (clinical spine, forearm, hip
or shoulder fracture) based on clinical risk factors alone
or the combination of clinical risk factors plus BMD. The
FRAX algorithms are suitable for men and women aged
40 years and older who are not receiving treatment for
osteoporosis. However, this method has been proposed
recently, and there is a small number of studies that estimate the possibility of its use in men [10, 12].
Taking into consideration the urgency of osteoporosis
for the global population and the constant search for improved diagnostic methods of structural-functional bone
state, «Med-Imaps» company patented a new methodology – «TBS iNsight®» in 2006. TBS iNsight® software is
an advanced application for DXA (GE Healthcare-Lunar
or Hologic) evaluating the quality of bone microarchitecture known as Trabecular Bone Score (TBS). TBS is
a texture analysis of bone X-ray images, embedded in
the software and able in seconds to improve the osteoporosis diagnosis. It enables the doctor to identify the
patients with a high fracture risk and also to select the
appropriate treatment.
The aim of the study was to evaluate the BMD, TBS
and the 10-year probability of major osteoporotic fractures and hip fractures in the healthy men of different ages.
Trabecular bone score, bone mineral density and 10-year fracture probability in Ukrainian men of different ages
Materials and methods
We’ve examined 300 men aged 40–89 years (mean
age – 60.9 ± 0.6 yrs; mean height – 1.74 ± 0.04 m; mean
weight – 84.1 ± 0.9 kg), who were divided into groups
depending on their age: 40–49 yrs (n = 52), 50–59 yrs
(n = 86), 60–69 yrs (n = 89), 70–79 yrs (n = 59), 80–89 yrs
(n = 14). The 10-year probability of hip fracture and the 10year probability of major osteoporotic fracture risk were
calculated by the Austrian, Polish and Russian FRAX®
models. BMD of the whole body, PA lumbar spine and
proximal femur were measured using the DXA method
(Prodigy, GE Lunar, Madison, WI, USA) and PA spine
TBS were assessed by the TBS iNsight® software package installed on the available DXA machine (Med-Imaps,
Pessac, France).
Results
The age significantly influenced the BMD of lumbar
spine (F = 2.84, р = 0.02) and femoral neck (F = 4.08,
р = 0.003) in all the examined patients (Figs. 1, 2).
A significantly decreased TBS (L1–L4) was determined
in men according to their ages (40–49 yrs – 1.116 ± 0.02,
50–59 yrs – 1.111 ± 0.02; 60–69 yrs – 1.118 ± 0.02; 70–
79 yrs – 1.062 ± 0.02, 80–89 yrs – 1.080 ± 0.05; F = 2.42,
р = 0.048) (Fig. 3).
We have observed a significant increase of a 10-year
probability of major osteoporotic fractures in the men aged
80–89 yrs (р < 0.01) using the Russian FRAX® model,
60–89 yrs (р < 0.01) – Austrian FRAX® model, 70–89 yrs
(р < 0.01) – Polish FRAX® model in comparison with
the men aged 40–49 yrs. The 10-year probability of hip
Fig. 1. BMD of the lumbar spine (L1–L4) in men
depending on their ages
Fig. 2. BMD of the femoral neck in men
depending on their ages
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V. Povoroznyuk, A. Musiienko, N. Dzerovych, D. Hans
Fig. 3. TBS in Ukrainian men depending on their
ages
Table.
Ten-year probability of osteoporotic fractures (%) according to the Austrian, Polish and Russian FRAX® models
А
Age / Risk factors
В
without BMD
with BMD
without BMD
with BMD
5.18 ± 0.26
5.18 ± 0.23
5.22 ± 0.21
6.04 ± 0.40
8.74 ± 1.28
6.51 ± 0.45
6.61 ± 0.38
5.87 ± 0.29
6.00 ± 0.63
6.41 ± 1.08
0.24 ± 0.04
0.39 ± 0.04
0.66 ± 0.05
2.00 ± 0.27
4.73 ± 1.29
0,87 ± 0,23
1,11 ± 0,22
0,89 ± 0,11
2,11 ± 0,54
3,05 ± 1,02
40–49
50–59
60–69
70–79
80–89
Poland
3.38 ± 0.22
4.32 ± 0.22
5.38 ± 0.25
8.87 ± 0.69
16.09 ± 2.22
4.41 ± 0.38
5.97 ± 0.46
6.23 ± 0.39
8.90 ± 1.13
11.85 ± 1.96
0.26 ± 0.04
0.61 ± 0.06
1.33 ± 0.11
4.48 ± 0.60
10.24 ± 2.18
0,89 ± 0,22
1,79 ± 0,36
1,82 ± 0,25
4,66 ± 1,07
6,44 ± 1,88
40–49
50–59
60–69
70–79
80–89
1.98 ± 0.11
2.28 ± 0.12
2.57 ± 0.12
3.93 ± 0.31
8.41 ± 1.47
2.54 ± 0.21
3.29 ± 0.27
3.00 ± 0.19
4.36 ± 0.65
5.97 ± 1.20
0.17 ± 0.02
0.36 ± 0.03
0.64 ± 0.05
1.80 ± 0.25
5.54 ± 1.47
0,53 ± 0,13
1,04 ± 0,20
0,89 ± 0,12
1,97 ± 0,50
3,44 ± 1,16
Russia
40–49
50–59
60–69
70–79
80–89
Austria
Note: А – 10-year probability of a major osteoporotic fracture; В – 10-year probability of a hip fracture.
Fig. 4. TBS in men depending on their status of
bone mineral density
Trabecular bone score, bone mineral density and 10-year fracture probability in Ukrainian men of different ages
Fig. 5. Regression curve describing the relationship
between TBS and BMD L1–L4 (TBS L1–L4 =
1.0081 + 0.085 * Х; r = 0.12; p = 0.03)
fractures significantly increased in the men aged 70–89 yrs
in comparison with those aged 40–69 yrs (р < 0.01).
TBS was significantly higher in men with normal
BMD (1.121 ± 0.01), compared with the patients who
have been diagnosed with an osteoporosis – 1.066 ± 0.03
(р = 0.04) (Fig. 4).
The significant correlation was observed between TBS
and BMD L1–L4 in the examined men (r = 0.12; p = 0.03).
No correlation was found between TBS and BMD of femoral neck (Fig. 5).
Conclusion
The TBS significantly decreased with ageing. Subjects
with osteoporosis have significantly lower TBS data compared with the examined patients with a normal BMD. A
significant correlation was found between the TBS and
BMD of lumbar spine. The 10-year probability of a major osteoporotic fracture and hip fracture significantly
increased in men with age. The trabecular bone score is
an independent parameter for evaluation of the structural-functional bone state. We can use the TBS in combination with FRAX and BMD for the improved diagnosis
of bone and joint diseases.
References
1. Clinician’s Guide to Prevention and Treatment of
Osteoporosis. National Osteoporosis Foundation. 2013.
2. Hans D, Goertzen AL, Krieg MA, Leslie WD. One
microarchitecture assessed by TBS predicts osteoporotic
fractures independent of bone density: The Manitoba study. J Bone Miner Res. 2011; 26(11): 2762–9.
3. Поворознюк В.В. Захворювання кістковом’язової системи в людей різного віку (вибрані лекції,
огляди, статті): У 3-х томах. К., 2009: 664 c.
4. Беневоленская Л.И., Лесняк О.М. Клинические
рекомендации “Остеопороз. Диагностика, профи­
лактика и лечение”, 2-е изд., перераб. и доп. М.:
ГЭОТАР Медиа. 2009: 272 с.
5. Official Positions of the International Society for
Clinical Densitometry,©Copyright ISCD, October 2007,
Supersedes all prior “Official Positions” publications.
6. Ebeling PR. Osteoporosis in Men. N Engl J Med.
2008; 14: 1474–82.
7. Bilezikian JP. Osteoporosis in men. J Clin Endocrinol Metab. 1999; 84: 3431–4.
8. Byberg L, Gedeborg R, Cars T, et al. Prediction
of fracture risk in men. J Bone Miner Res. 2012; 27(4):
797–807.
9. Adler RA. Osteoporosis in men: insights for the
clinician. Ther Adv Musculoskelet Dis. 2011; 3(4):
191–200.
10. Kanis JA, McCloskey E, Johansson H, et al.
FRAX(®) with and without bone mineral density. Calcif
Tissue Int. 2012; 1: 1–13.
11. Kanis JA, Johnell O, Oden A, et al. FRAX and the
assessment of fracture probability in men and women from
the UK. Osteoporos Int. 2008; 19: 385–97.
12. Поворознюк ВВ, Григорьева НВ. Роль FRAX
в прогнозировании риска переломов. Боль. Суставы.
Позвоночник. 2011; 2: 19–28.
Received: November 21, 2013
Accepted: March 6, 2014
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V. Povoroznyuk, A. Musiienko, N. Dzerovych, D. Hans
Ukrainos Skirtingo amžiaus vyrų TRABEKULINIO
KAULO INDEKSAS, kaulų mineralų tankis ir
lūžių tikimybė PER 10 metų
Vladyslav Povoroznyuk1, Anna Musiienko1, Nataliya Dzerovych1,
Didier Hans2
1 NAMS Gerontologijos institutas, Ukraina, Osteoporozės problemų
mokslo medicinos centras, Kijevas, Ukraina
Kaulo ligų centras, Lozanos universitetinė ligoninė, Lozana,
2 Šveicarija
Santrauka
Tyrimo tikslas. Įvertinti skirtingo amžiaus sveikų vyrų kaulų
mineralų tankį, trabekulinio kaulo indeksą ir pagrindinių osteoporozinių bei šlaunikaulio lūžių tikimybę 10 metų laikotarpyje.
Tyrimo metodai. Tyrimo metu buvo ištirta 300 vyrų, 40–89
metų amžiaus (amžiaus vidurkis – 60,9 ± 0,6 metai, ūgio vidurkis – 1,74 ± 0,04 m., kūno masės vidurkis – 84,1 ± 0,9 kg), tiriamieji buvo suskirti į grupes pagal amžių: 40–49 metų (n = 52),
50–59 metų (n = 86), 60–69 metų (n=89), 70–79 metų (n = 59),
80–89 metų (n = 14). Šlaunikaulio ir pagrindinių osteoporozinių
lūžių tikimybės per 10 metų laikotarpį buvo apskaičiuotos pritaikius Austrijos, Lenkijos ir Rusijos FRAX modelius. Viso kūno,
juosmeninės stuburo dalies ir šlaunikaulio proksimalinės dalies
kaulų mineralų tankis buvo nustatytos dvisrautės radioabsorbciometrijos tyrimu (Prodigy, GE Lunar, Madison, WI, USA),
stuburo trabekulinio kaulo indeksas – iNsight® programiniu
paketu, kuris įdiegtas į dvisrautės radioabsorbciometrijos tyrimo
įrenginį (Med-Imaps, Pessac, France)
Rezultatai. Visų tyrimo dalyvių juosmeninės stuburo dalies
(F = 2,84; р = 0,02) ir šlaunikaulio kaklo (F = 4,08; р = 0,003)
kaulų mineralų tankis yra reikšmingai įtakojamas amžiaus.
Reikšmingai trabekulinio kaulo indeksas (L1–L4) sumažėja
šiose vyrų amžiaus grupėse: 40–49 metų – 1,116 ± 0,02;
50–59 metų – 1,111 ± 0,02; 60–69 metų – 1,118 ± 0,02; 70–79
metų – 1,062 ± 0,02, 80–89 metų – 1,080 ± 0,05 (F = 2,42;
р = 0,048). Nustatėme, kad 10 metų laikotarpyje pagrindinių
lūžių tikimybė didėjo 80–89 metų (р < 0,01; Rusijos FRAX
modelis) 60–89 metų (р < 0,01; Austrijos FRAX modelis),
70–89 metų (р < 0,01, Lenkijos FRAX modelis) amžiaus vyrų
grupėse palyginus su 40–49 metų vyrų grupėmis. Įvertinus vyrų
šlaunikaulio lūžių tikimybę 10 metų laikotarpyje, nustatėme,
kad lūžių tikimybė didėja 70–89 metų amžiuje palyginus
su 40–69 metų vyrų grupe. trabekulinio kaulo indeksas yra
reikšmingai didesnis vyrų grupėje su normaliu kaulų mineralų
tankiu (1,121 ± 0,01) palyginus su pacientais, kuriems buvo
diagnozuota osteoporozė 1,066 ± 0,03 (р = 0,04). Nustatytas
koreliacinis ryšis vyrų grupėse tarp trabekulinio kaulo indekso
ir kaulų mineralų tankio L1–L4 (r = 0,12; p = 0,03). Nenustatyta sąsajų tarp trabekulinio kaulo indekso ir šlaunikaulio
kaklo kaulų mineralų tankio.
Išvados. Kaulų trabekulinis indeksas mažėja su amžiumi.
Tiriamiesiems su diagnozuota osteoporoze nustatytas reikšmingai mažesnis trabekulinio kaulo indeksas negu pacientams
su normaliu kaulų mineralų tankiu. Nustatytos reikšmingos
sąsajos tarp trabekulinio kaulo indekso ir kaulų mineralų tankio
juosmeninėje stuburo dalyje. Vyrų svarbiausiųjų osteoporozinių lūžių tikimybė per 10 metų reikšmingai didėja su amžiumi.
Trabekulinio kaulo indeksas yra nepriklausomas parametras,
atspindintis struktūrinius-funkcinius kaulų pokyčius. Gerinant
kaulų ir sąnarių ligų diagnostiką rekomenduojame kartu su
FRAX ir kaulų mineralų tankiu vertinti ir trabekulinio kaulo
indeksą.
Reikšminiai žodžiai:
trabekulinio kaulo indeksas, kaulų mineralų tankis, lūžiai