根据水平特异性差异调整小梁骨评分(TBS)可减少脊椎排除患者基于FRAX®的治疗重新分类:曼尼托巴省BMD登记处。

IF 1.7 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM
William D. Leslie , Neil Binkley , Heenam Goel , Didier Hans , Eugene V. McCloskey
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引用次数: 2

摘要

小梁骨评分(TBS)是骨折预测的FRAX®独立风险因素。TBS值从头部到尾部增加,TBSL1-L4与单个腰椎之间的平均差异如下:L1-0.093、L2-0.008、L3+0.055和L4+0.046。排除脊椎水平可能会影响基于FRAX的治疗建议,接近干预阈值。我们研究了在因结构伪影而导致脊椎排斥的个体中,调整水平特异性TBS差异对基于TBS调整的FRAX的治疗建议的影响。我们通过曼尼托巴省骨密度计划确定了71209名年龄≥40岁的TBS和FRAX计算患者。在24428名脊椎排除患者中,使用这些水平特异性因素调整TBS与TBSL1-L4一致(平均差异0.001)。我们比较了在调整水平特异性TBS差异前后,基于FRAX的TBSL1-L4和非排除脊椎水平的治疗建议。在基线严重骨质疏松性骨折风险≥15%的患者中,与TBSL1-L4相比,10.6%的受试者因脊椎排除而进行的TBS重新分类了基于FRAX的治疗,在调整了水平特异性差异后,这一比例降至7.2%。在11131名使用L1-L2进行BMD报告的患者中(最常见的排除模式,TBS效应最大),治疗重新分类分别从13.9%降至2.4%。在基线髋部骨折风险≥2%的个体中,与TBSL1-L4相比,TBS椎骨排除重新分类了7.1%,但在调整了水平特异性差异后仅为4.5%。当L1-L2用于BMD报告时,髋关节骨折风险的治疗重新分类从9.2%降低到5.2%。总之,基于TBS和TBS调整的FRAX的治疗建议受到椎骨层面结构伪影排除的影响。根据TBS的水平特异性差异进行调整可减少基于FRAX的治疗建议中的重新分类。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adjusting Trabecular Bone Score (TBS) for level-specific differences reduces FRAX®-based treatment reclassification in patients with vertebral exclusions: The Manitoba BMD Registry

Trabecular bone score (TBS) is a FRAX®-independent risk factor for fracture prediction. TBS values increase from cranial to caudal, with the following mean differences between TBSL1-L4 and individual lumbar vertebrae: L1 −0.093, L2 −0.008, L3 +0.055 and L4 +0.046. Excluding vertebral levels can affect FRAX-based treatment recommendations close to the intervention threshold. We examined the effect of adjusting for level-specific TBS differences in individuals with vertebral exclusions due to structural artifact on TBS-adjusted FRAX-based treatment recommendations. We identified 71,209 individuals aged ≥40 years with TBS and FRAX calculations through the Manitoba Bone Density Program. In the 24,428 individuals with vertebral exclusions, adjusting TBS using these level-specific factors agreed with TBSL1-L4 (mean difference −0.001). We compared FRAX-based treatment recommendations for TBSL1-L4 and for non-excluded vertebral levels before and after adjusting for level-specific TBS differences. Among those with baseline major osteoporotic fracture risk ≥15 %, TBS with vertebral exclusions reclassified FRAX-based treatment in 10.6 % of individuals compared with TBSL1-L4, and was reduced to 7.2 % after adjusting for level-specific differences. In 11,131 patients where L1–L2 was used for BMD reporting (the most common exclusion pattern with the largest TBS effect), treatment reclassification was reduced from 13.9 % to 2.4 %, respectively. Among individuals with baseline hip fracture risk ≥2 %, TBS vertebral exclusions reclassified 7.1 % compared with TBSL1-L4, but only 4.5 % after adjusting for level-specific differences. When L1–L2 was used for BMD reporting, treatment reclassification from hip fracture risk was reduced from 9.2 % to 5.2 %. In conclusion, TBS and TBS-adjusted FRAX-based treatment recommendations are affected by vertebral level exclusions for structural artifact. Adjusting for level-specific differences in TBS reduces reclassification in FRAX-based treatment recommendations.

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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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