Skip to main content
Top
Published in: Osteoporosis International 2/2016

01-02-2016 | Original Article

Predictors of trabecular bone score in school children

Authors: K. Shawwa, A. Arabi, M. Nabulsi, J. Maalouf, M. Salamoun, M. Choucair, D. Hans, G. El-Hajj Fuleihan

Published in: Osteoporosis International | Issue 2/2016

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Hansen MA, Overgaard K, Riis BJ, Christiansen C (1991) Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. BMJ 303:961–964PubMedCentralCrossRefPubMed Hansen MA, Overgaard K, Riis BJ, Christiansen C (1991) Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. BMJ 303:961–964PubMedCentralCrossRefPubMed
2.
go back to reference Adler RA (ed) (2010) Osteoporosis: pathophysiology and clinical management. Humana Press, New York Adler RA (ed) (2010) Osteoporosis: pathophysiology and clinical management. Humana Press, New York
3.
go back to reference 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 19:9–12CrossRefPubMed 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 19:9–12CrossRefPubMed
4.
go back to reference 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 285:785CrossRef 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 285:785CrossRef
5.
go back to reference 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 342:7254CrossRef 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 342:7254CrossRef
6.
go back to reference 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 91:405–412CrossRefPubMed 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 91:405–412CrossRefPubMed
7.
go back to reference 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 56:296–303CrossRefPubMed 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 56:296–303CrossRefPubMed
8.
go back to reference 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 26:2762–2769CrossRefPubMed 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 26:2762–2769CrossRefPubMed
9.
go back to reference 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 29:518–530CrossRefPubMed 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 29:518–530CrossRefPubMed
10.
go back to reference 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 78:216–224CrossRefPubMed 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 78:216–224CrossRefPubMed
11.
go back to reference Ulivieri FM, Silva BC, Sardanelli F, Hans D, Bilezikian JP, Caudarella R (2014) Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine 47:435–448CrossRefPubMed Ulivieri FM, Silva BC, Sardanelli F, Hans D, Bilezikian JP, Caudarella R (2014) Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine 47:435–448CrossRefPubMed
13.
go back to reference Tanner J (1978) Physical growth and development. In: Forfar JO, Arneil G (eds) Textbook of paediatrics. Churchill Livingstone, Edinburgh, pp 249–303 Tanner J (1978) Physical growth and development. In: Forfar JO, Arneil G (eds) Textbook of paediatrics. Churchill Livingstone, Edinburgh, pp 249–303
14.
go back to reference El-Hajj Fuleihan G, Vieth R (2007) Vitamin D insufficiency and musculoskeletal health in children and adolescents. Int Congr Ser 1297:91–108CrossRef El-Hajj Fuleihan G, Vieth R (2007) Vitamin D insufficiency and musculoskeletal health in children and adolescents. Int Congr Ser 1297:91–108CrossRef
15.
go back to reference 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 12:652–655CrossRefPubMed 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 12:652–655CrossRefPubMed
16.
go back to reference Gordon CM, Leonard MB, Zemel BS, International Society for Clinical D (2014) 2013 Pediatric Position Development Conference: executive summary and reflections. J Clin Densitom 17:219–224CrossRefPubMed Gordon CM, Leonard MB, Zemel BS, International Society for Clinical D (2014) 2013 Pediatric Position Development Conference: executive summary and reflections. J Clin Densitom 17:219–224CrossRefPubMed
17.
go back to reference 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 12:170–176CrossRefPubMed 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 12:170–176CrossRefPubMed
18.
go back to reference Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305–1319CrossRefPubMed Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305–1319CrossRefPubMed
19.
go back to reference 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 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.
go back to reference Leslie WD, Krieg MA, Hans D, Manitoba Bone Density Program (2013) Clinical factors associated with trabecular bone score. J Clin Densitom 16:374–379CrossRefPubMed Leslie WD, Krieg MA, Hans D, Manitoba Bone Density Program (2013) Clinical factors associated with trabecular bone score. J Clin Densitom 16:374–379CrossRefPubMed
21.
go back to reference 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 25:1759–1764CrossRefPubMed 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 25:1759–1764CrossRefPubMed
22.
go back to reference Leib E, Winzenrieth R, Aubry-Rozier B, Hans D (2013) Vertebral microarchitecture and fragility fracture in men: a TBS study. Bone 62:51–55CrossRefPubMed Leib E, Winzenrieth R, Aubry-Rozier B, Hans D (2013) Vertebral microarchitecture and fragility fracture in men: a TBS study. Bone 62:51–55CrossRefPubMed
23.
go back to reference 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 17:434–435CrossRefPubMed 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 17:434–435CrossRefPubMed
24.
go back to reference 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 98:1963–1970PubMedCentralCrossRefPubMed 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 98:1963–1970PubMedCentralCrossRefPubMed
25.
go back to reference 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 25:1945–1951CrossRefPubMed 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 25:1945–1951CrossRefPubMed
26.
go back to reference 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 24:1073–1078CrossRefPubMed 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 24:1073–1078CrossRefPubMed
27.
go back to reference 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 24:2837–2846CrossRefPubMed 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 24:2837–2846CrossRefPubMed
28.
go back to reference 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 28:449–454CrossRefPubMed 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 28:449–454CrossRefPubMed
29.
go back to reference 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 17:66–71CrossRefPubMed 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 17:66–71CrossRefPubMed
30.
go back to reference 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 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
Metadata
Title
Predictors of trabecular bone score in school children
Authors
K. Shawwa
A. Arabi
M. Nabulsi
J. Maalouf
M. Salamoun
M. Choucair
D. Hans
G. El-Hajj Fuleihan
Publication date
01-02-2016
Publisher
Springer London
Published in
Osteoporosis International / Issue 2/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-015-3255-2

Other articles of this Issue 2/2016

Osteoporosis International 2/2016 Go to the issue