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Added clinical use of trabecular bone score to BMD for major osteoporotic fracture prediction in older Chinese people: the Mr. OS and Ms. OS cohort study in Hong Kong

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Abstract

Summary

The thresholds of trabecular bone score (TBS) require validation for clinical application in older Chinese people. The lower threshold of TBS significantly improved the accuracy of prediction by bone mineral density-based osteoporosis status for major osteoporotic fracture in older Chinese men.

Introduction

Trabecular bone score (TBS) is a relatively new indicator of skeletal fragility. Its clinical application warrants further investigations. Our aim was to validate and recommend practical thresholds of TBS for fracture prediction in older Chinese people.

Methods

Older men and women in Mr. and Ms. Os (Hong Kong) study were followed up for an average of 9.94 ± 2.77 and 8.82 ± 1.49 years, respectively. Major osteoporotic fracture (MOF) risks of TBS category in each BMD category (normal, osteopenia, or osteoporosis) were compared using Poisson regression model. The improved fracture risk prediction power was evaluated by the sensitivity, the specificity, the area under the receiver-operating characteristic curve (AUC), and the net reclassification improvement index (NRI).

Results

MOF incidence gradually increased with the increased risk categories of bone mineral density (BMD) and tertiles of TBS both in men and women. Compared with the lowest risk category, the rate ratios (RR, 95 % CI) of MOF for osteoporosis with the lowest TBS was 9.66 (4.19–22.26) and 6.24 (1.53–25.42) in men and women, respectively. The fracture risk for osteopenic men with the lowest TBS was significantly higher than that for normal men, with RR (95 % CI) of 4.68 (2.11–10.41). The predictive power of osteoporosis alone was significantly improved by TBS in men [mean AUC (95 % CI) rose from 0.604 (0.562–0.646) to 0.666 (0.623–0.710) and sensitivity rose from 32.5 to 64.3 %]. The improvement in predictive power was not significant in older women.

Conclusions

TBS in combination with BMD can predict MOF more reliably in older men than by BMD alone.

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Acknowledgments

The authors wish to thank all the participants dedicated in contributing to the study and The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control supporting the study. The study was funded by the National Institutes of Health R01 grant AR049439–01A1 and the Research Grants Council Earmarked Grant CUHK4101/02 M.

Author information

Authors and Affiliations

  1. Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China

    Y. Su

  2. Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China

    J. Leung & T. Kwok

  3. Bone Diseases Unit, DAL, Lausanne University Hospital, Avenue Pierre-Decker 4, Lausanne, Switzerland

    D. Hans & B. Aubry-Rozier

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  1. Y. Su
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  2. J. Leung
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  4. B. Aubry-Rozier
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  5. T. Kwok
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Corresponding author

Correspondence to T. Kwok.

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Conflicts of interest

TBS iNsight Software is a product of Med-Imaps. Didier Hans is the co-owner of the TBS patent and has corresponding ownership shares. Yi Su, Jason Leung, Bérengère Aubry-Rozier, and Timothy Kwok declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Su, Y., Leung, J., Hans, D. et al. Added clinical use of trabecular bone score to BMD for major osteoporotic fracture prediction in older Chinese people: the Mr. OS and Ms. OS cohort study in Hong Kong. Osteoporos Int 28, 151–160 (2017). https://doi.org/10.1007/s00198-016-3785-2

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