肺移植候选者骨矿物质密度和骨小梁微结构筛选

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology Pub Date : 2025-03-01 DOI:10.1016/j.jacr.2024.12.009

Alain E. Sherman MD, MBA , Aspan M. Shokrekhuda MD , Deepak P. Kalbi MD , Jenny T. Bencardino MD , Kwang J. Chun MD

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引用次数: 0

摘要

目的：由于继发于合并症的骨质疏松风险增加和免疫抑制时间延长，肺移植候选者常规接受双能x线吸收仪（DXA）筛查。尽管如此，即使在骨密度正常的患者中，术后不全性骨折也有很好的文献记载。本研究探讨骨小梁评分（TBS）作为骨微结构补充筛查指标的附加价值。方法对143例术前行DXA筛查的肺移植患者进行回顾性分析。通过腰椎DXA计算TBS。DXA和TBS测量采用参照已建立的基于人群的数据集的t评分进行标准化。结果两组患者骨质减少率（36.4%）、骨质疏松率（11.2%）、骨部分降解率（35.0%）、骨降解率（35.0%）比较，差异均有统计学意义(P <；措施)。小梁微结构异常明显高于骨密度异常(69.9% vs 47.6%；P & lt;措施)。TBS t评分（mean = - 1.98, SD = 1.39）平均显著低于DXA t评分(mean = - 0.80, SD = 1.57；T [142] = 9.09；P & lt;措施)。西班牙裔患者（平均= - 1.25,SD = 1.28）的DXA t评分显著低于白人患者（平均= - 0.28,SD = 1.14）或黑人患者(平均= - 0.30,SD = 1.31；F[2,109] = 8.28；P & lt;措施)。相比之下，TBS t -评分没有种族或民族差异(F[2,109] = 0.26；P = .78)。结论骨小梁微结构受损在肺移植候选患者中极为常见，尽管骨密度正常，但仍有相当比例的患者存在骨退化导致骨折的风险。TBS有望作为一种简单、有效、廉价、无创的筛查手段，在这一独特和脆弱的人群中辅助DXA。

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Bone Mineral Density and Trabecular Microarchitecture Screening in Lung Transplant Candidates

Purpose

Lung transplant candidates routinely undergo dual-energy x-ray absorptiometry (DXA) screening due to increased risk of osteoporosis secondary to comorbidities and prolonged immunosuppression. Nonetheless, postoperative insufficiency fractures have been well documented, even in patients with normal bone mineral density (BMD). This study investigated the added value of trabecular bone score (TBS) as a complementary screening index of bone microarchitecture.

Methods

A retrospective review of 143 lung transplant candidates who underwent preoperative DXA screening was performed. TBS was calculated from DXA of the lumbar spine. DXA and TBS measurements were standardized using T-scores with reference to established population-based datasets.

Results

Differences in the observed rates of osteopenia (36.4%), osteoporosis (11.2%), partially degraded bone (35.0%), and degraded bone (35.0%) were statistically significant (P < .001). Abnormal trabecular microarchitecture was significantly more prevalent than abnormal BMD (69.9% versus 47.6%; P < .001). TBS T-scores (mean = −1.98, SD = 1.39) were, on average, significantly lower than DXA T-scores (mean = −0.80, SD = 1.57; t[142] = 9.09; P < .001). Hispanic patients (mean = −1.25, SD = 1.28) had significantly lower DXA T-scores compared with White (mean = −0.28, SD = 1.14) or Black patients (mean = −0.30, SD = 1.31; F[2, 109] = 8.28; P < .001). By contrast, TBS T-scores did not differ by race or ethnicity (F[2, 109] = 0.26; P = .78).

Conclusions

Impaired trabecular microarchitecture is extremely common among lung transplant candidates, with a substantial proportion at risk of fracture through degraded bone despite normal BMD. TBS offers promise as a simple, robust, inexpensive, and noninvasive screening adjunct to DXA in this unique and vulnerable population.

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来源期刊

Journal of the American College of Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

6.30

自引率

8.90%

发文量

312

审稿时长

34 days

期刊介绍： The official journal of the American College of Radiology, JACR informs its readers of timely, pertinent, and important topics affecting the practice of diagnostic radiologists, interventional radiologists, medical physicists, and radiation oncologists. In so doing, JACR improves their practices and helps optimize their role in the health care system. By providing a forum for informative, well-written articles on health policy, clinical practice, practice management, data science, and education, JACR engages readers in a dialogue that ultimately benefits patient care.