骨小梁评分的临床应用:2023 ISCD官方立场:TBS的临床应用

IF 1.7 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM
Heenam Goel, Neil Binkley, Miranda Boggild, Wing P. Chan, William D. Leslie, Eugene McCloskey, Sarah L. Morgan, Barbara C. Silva, Angela M. Cheung
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引用次数: 0

摘要

目前,骨质疏松症可通过应用世卫组织骨密度分类(BMD)进行诊断,该分类由双能x射线吸收仪(DXA)评估。然而,骨密度以外的骨骼因素会影响骨骼强度和骨折风险。腰椎TBS是一种基于DXA图像的灰度纹理测量方法,已被广泛研究,它增强了独立于BMD的骨折预测,可用于调整FRAX®的骨折概率,以改善风险分层。国际临床密度测量学会工作组的目的是审查现有证据并提出建议,以协助临床医生何时以及如何执行、报告和利用TBS。我们的综述得出结论,TBS最有可能改变年龄≥40岁、接近FRAX药物干预阈值的患者的临床管理。L1-L4椎体水平的TBS值,不排除椎体,应用于计算调整后的FRAX概率。L1-L4椎体水平可用于退行性改变和腰椎压缩性骨折。如果存在极端的结构或病理伪影,建议不要报告TBS。监测和报告TBS变化对当前版本的TBS算法不太可能有帮助。下一个版本的TBS软件将包括基于直接测量组织厚度的调整。预计这将提高性能,并解决影响当前算法的一些技术因素,随着使用新算法的经验的积累,这些技术因素可能需要对这些官方职位进行修改。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions

Osteoporosis can currently be diagnosed by applying the WHO classification to bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA). However, skeletal factors other than BMD contribute to bone strength and fracture risk. Lumbar spine TBS, a grey-level texture measure which is derived from DXA images has been extensively studied, enhances fracture prediction independent of BMD and can be used to adjust fracture probability from FRAX® to improve risk stratification. The purpose of this International Society for Clinical Densitometry task force was to review the existing evidence and develop recommendations to assist clinicians regarding when and how to perform, report and utilize TBS. Our review concluded that TBS is most likely to alter clinical management in patients aged ≥ 40 years who are close to the pharmacologic intervention threshold by FRAX. The TBS value from L1-L4 vertebral levels, without vertebral exclusions, should be used to calculate adjusted FRAX probabilities. L1-L4 vertebral levels can be used in the presence of degenerative changes and lumbar compression fractures. It is recommended not to report TBS if extreme structural or pathological artifacts are present. Monitoring and reporting TBS change is unlikely to be helpful with the current version of the TBS algorithm. The next version of TBS software will include an adjustment based upon directly measured tissue thickness. This is expected to improve performance and address some of the technical factors that affect the current algorithm which may require modifications to these Official Positions as experience is acquired with this new algorithm.

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来源期刊
Journal of Clinical Densitometry
Journal of Clinical Densitometry 医学-内分泌学与代谢
CiteScore
4.90
自引率
8.00%
发文量
92
审稿时长
90 days
期刊介绍: The Journal is committed to serving ISCD''s mission - the education of heterogenous physician specialties and technologists who are involved in the clinical assessment of skeletal health. The focus of JCD is bone mass measurement, including epidemiology of bone mass, how drugs and diseases alter bone mass, new techniques and quality assurance in bone mass imaging technologies, and bone mass health/economics. Combining high quality research and review articles with sound, practice-oriented advice, JCD meets the diverse diagnostic and management needs of radiologists, endocrinologists, nephrologists, rheumatologists, gynecologists, family physicians, internists, and technologists whose patients require diagnostic clinical densitometry for therapeutic management.
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