A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX

E.V. McCloskey; A. Oden; N.C. Harvey; W.D. Leslie; D. Hans; H. Johansson; R. Barkmann; S. Boutroy; J. Brown; R. Chapurlat; P. J. M. Elders; Yuki Fujita; C. C. Gluer; D. Goltzman; M. Iki; M. Karlsson; A. Kindmark; M. Kotowicz; N. Kurumatani; Terry Kwok; O. Lamy; J. Leung; K. Lippuner; O. Ljunggren; M. Lorentzon; D. Mellstrom; T. Merlijn; L. Oei; C. Ohlsson; J. A. Pasco; F. Rivadeneira; B. Rosengren; E. Sornay-Rendu; P. Szulc; J. Tamaki; John A. Kanis

doi:https://doi.org/10.1002/jbmr.2734

A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX

E.V. McCloskey, A. Oden, N.C. Harvey, W.D. Leslie, D. Hans, H. Johansson, R. Barkmann, S. Boutroy, J. Brown, R. Chapurlat, P. J. M. Elders, Yuki Fujita, C. C. Gluer, D. Goltzman, M. Iki, M. Karlsson, A. Kindmark, M. Kotowicz, N. Kurumatani, Terry KwokO. Lamy, J. Leung, K. Lippuner, O. Ljunggren, M. Lorentzon, D. Mellstrom, T. Merlijn, L. Oei, C. Ohlsson, J. A. Pasco, F. Rivadeneira, B. Rosengren, E. Sornay-Rendu, P. Szulc, J. Tamaki, John A. Kanis

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Abstract

Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. (C) 2015 American Society for Bone and Mineral Research.

Original language	English
Pages (from-to)	940-948
Number of pages	9
Journal	Journal of bone and mineral research
Volume	31
DOIs	https://doi.org/10.1002/jbmr.2734
Publication status	Published - 2016

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https://doi.org/10.1002/jbmr.2734

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McCloskey, E. V., Oden, A., Harvey, N. C., Leslie, W. D., Hans, D., Johansson, H., Barkmann, R., Boutroy, S., Brown, J., Chapurlat, R., Elders, P. J. M., Fujita, Y., Gluer, C. C., Goltzman, D., Iki, M., Karlsson, M., Kindmark, A., Kotowicz, M., Kurumatani, N., ... Kanis, J. A. (2016). A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX. Journal of bone and mineral research, 31, 940-948. https://doi.org/10.1002/jbmr.2734

@article{1396f0b9460e40fbb0e2584f7326d7c0,

title = "A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX",

abstract = "Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. (C) 2015 American Society for Bone and Mineral Research.",

author = "E.V. McCloskey and A. Oden and N.C. Harvey and W.D. Leslie and D. Hans and H. Johansson and R. Barkmann and S. Boutroy and J. Brown and R. Chapurlat and Elders, {P. J. M.} and Yuki Fujita and Gluer, {C. C.} and D. Goltzman and M. Iki and M. Karlsson and A. Kindmark and M. Kotowicz and N. Kurumatani and Terry Kwok and O. Lamy and J. Leung and K. Lippuner and O. Ljunggren and M. Lorentzon and D. Mellstrom and T. Merlijn and L. Oei and C. Ohlsson and Pasco, {J. A.} and F. Rivadeneira and B. Rosengren and E. Sornay-Rendu and P. Szulc and J. Tamaki and Kanis, {John A.}",

note = "M1 - 5 ISI Document Delivery No.: DN7PX Times Cited: 26 Cited Reference Count: 66 McCloskey, Eugene V. Oden, Anders Harvey, Nicholas C. Leslie, William D. Hans, Didier Johansson, Helena Barkmann, Reinhard Boutroy, Stephanie Brown, Jacques Chapurlat, Roland Elders, Petra J. M. Fujita, Yuki Glueer, Claus-C Goltzman, David Iki, Masayuki Karlsson, Magnus Kindmark, Andreas Kotowicz, Mark Kurumatani, Norio Kwok, Timothy Lamy, Oliver Leung, Jason Lippuner, Kurt Ljunggren, Osten Lorentzon, Mattias Mellstroem, Dan Merlijn, Thomas Oei, Ling Ohlsson, Claes Pasco, Julie A. Rivadeneira, Fernando Rosengren, Bjorn Sornay-Rendu, Elisabeth Szulc, Pawel Tamaki, Junko Kanis, John A. Kwok, Timothy/C-3725-2008 Kwok, Timothy/0000-0001-9253-3549; Mellstrom, Dan/0000-0003-2761-3723 MediMaps; Amgen; Lilly; Merck; Alliance for Better Bone Health; Consilient; GE Lunar; GSK; Hologic; Internis; Novartis; ONO; Pfizer; Roche; Servier; UCB; Wyeth; Shire; MEDA; Shire HGT; NIH (US); RGC (HK); Genzyme; NHMRC; Japanese Society for the Promotion of Science CG has received consulting fees or honoraria and travel support from MediMaps. DG is a Board member or received consultancy fees from Amgen and Lilly. His institution has received research funding from Amgen, Lilly and Merck. DH is the President of Medimaps. EVM and/or his institution have received consultancy fees, research funding and/or honoraria from the Alliance for Better Bone Health, Amgen, Consilient, GE Lunar, GSK, Hologic, Internis, Lilly, Merck, Novartis, ONO, Pfizer, Roche, Servier, UCB and Wyeth. NH and/or his institution have received consultancy fees, research funding and/or honoraria from the Alliance for Better Bone Health, Amgen, Consilient, Internis, Lilly, Merck, Servier and Shire. AK and/or his institution have received consultancy fees, research funding and/or honoraria for lectures/educational materials from the Amgen, Lilly, MEDA and Shire HGT. TK's institution has received research funding from NIH (US) and RGC (HK). WL and/or his institution have received research funding and/or honoraria Amgen, Genzyme, Lilly and Novartis. JP's institution has received research funding from NHMRC. JT's institution has received research funding from the Japanese Society for the Promotion of Science. 26 5 10 WILEY-BLACKWELL HOBOKEN J BONE MINER RES",

year = "2016",

doi = "https://doi.org/10.1002/jbmr.2734",

language = "English",

volume = "31",

pages = "940--948",

journal = "Bone and Mineral",

issn = "0169-6009",

publisher = "Elsevier BV",

}

McCloskey, EV, Oden, A, Harvey, NC, Leslie, WD, Hans, D, Johansson, H, Barkmann, R, Boutroy, S, Brown, J, Chapurlat, R, Elders, PJM, Fujita, Y, Gluer, CC, Goltzman, D, Iki, M, Karlsson, M, Kindmark, A, Kotowicz, M, Kurumatani, N, Kwok, T, Lamy, O, Leung, J, Lippuner, K, Ljunggren, O, Lorentzon, M, Mellstrom, D, Merlijn, T, Oei, L, Ohlsson, C, Pasco, JA, Rivadeneira, F, Rosengren, B, Sornay-Rendu, E, Szulc, P, Tamaki, J & Kanis, JA 2016, 'A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX', Journal of bone and mineral research, vol. 31, pp. 940-948. https://doi.org/10.1002/jbmr.2734

TY - JOUR

T1 - A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX

AU - McCloskey, E.V.

AU - Oden, A.

AU - Harvey, N.C.

AU - Leslie, W.D.

AU - Hans, D.

AU - Johansson, H.

AU - Barkmann, R.

AU - Boutroy, S.

AU - Brown, J.

AU - Chapurlat, R.

AU - Elders, P. J. M.

AU - Fujita, Yuki

AU - Gluer, C. C.

AU - Goltzman, D.

AU - Iki, M.

AU - Karlsson, M.

AU - Kindmark, A.

AU - Kotowicz, M.

AU - Kurumatani, N.

AU - Kwok, Terry

AU - Lamy, O.

AU - Leung, J.

AU - Lippuner, K.

AU - Ljunggren, O.

AU - Lorentzon, M.

AU - Mellstrom, D.

AU - Merlijn, T.

AU - Oei, L.

AU - Ohlsson, C.

AU - Pasco, J. A.

AU - Rivadeneira, F.

AU - Rosengren, B.

AU - Sornay-Rendu, E.

AU - Szulc, P.

AU - Tamaki, J.

AU - Kanis, John A.

N1 - M1 - 5 ISI Document Delivery No.: DN7PX Times Cited: 26 Cited Reference Count: 66 McCloskey, Eugene V. Oden, Anders Harvey, Nicholas C. Leslie, William D. Hans, Didier Johansson, Helena Barkmann, Reinhard Boutroy, Stephanie Brown, Jacques Chapurlat, Roland Elders, Petra J. M. Fujita, Yuki Glueer, Claus-C Goltzman, David Iki, Masayuki Karlsson, Magnus Kindmark, Andreas Kotowicz, Mark Kurumatani, Norio Kwok, Timothy Lamy, Oliver Leung, Jason Lippuner, Kurt Ljunggren, Osten Lorentzon, Mattias Mellstroem, Dan Merlijn, Thomas Oei, Ling Ohlsson, Claes Pasco, Julie A. Rivadeneira, Fernando Rosengren, Bjorn Sornay-Rendu, Elisabeth Szulc, Pawel Tamaki, Junko Kanis, John A. Kwok, Timothy/C-3725-2008 Kwok, Timothy/0000-0001-9253-3549; Mellstrom, Dan/0000-0003-2761-3723 MediMaps; Amgen; Lilly; Merck; Alliance for Better Bone Health; Consilient; GE Lunar; GSK; Hologic; Internis; Novartis; ONO; Pfizer; Roche; Servier; UCB; Wyeth; Shire; MEDA; Shire HGT; NIH (US); RGC (HK); Genzyme; NHMRC; Japanese Society for the Promotion of Science CG has received consulting fees or honoraria and travel support from MediMaps. DG is a Board member or received consultancy fees from Amgen and Lilly. His institution has received research funding from Amgen, Lilly and Merck. DH is the President of Medimaps. EVM and/or his institution have received consultancy fees, research funding and/or honoraria from the Alliance for Better Bone Health, Amgen, Consilient, GE Lunar, GSK, Hologic, Internis, Lilly, Merck, Novartis, ONO, Pfizer, Roche, Servier, UCB and Wyeth. NH and/or his institution have received consultancy fees, research funding and/or honoraria from the Alliance for Better Bone Health, Amgen, Consilient, Internis, Lilly, Merck, Servier and Shire. AK and/or his institution have received consultancy fees, research funding and/or honoraria for lectures/educational materials from the Amgen, Lilly, MEDA and Shire HGT. TK's institution has received research funding from NIH (US) and RGC (HK). WL and/or his institution have received research funding and/or honoraria Amgen, Genzyme, Lilly and Novartis. JP's institution has received research funding from NHMRC. JT's institution has received research funding from the Japanese Society for the Promotion of Science. 26 5 10 WILEY-BLACKWELL HOBOKEN J BONE MINER RES

PY - 2016

Y1 - 2016

N2 - Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. (C) 2015 American Society for Bone and Mineral Research.

AB - Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. (C) 2015 American Society for Bone and Mineral Research.

U2 - https://doi.org/10.1002/jbmr.2734

DO - https://doi.org/10.1002/jbmr.2734

M3 - Article

C2 - 26498132

SN - 0169-6009

VL - 31

SP - 940

EP - 948

JO - Bone and Mineral

JF - Bone and Mineral

ER -