The trabecular bone score: Relationships with trabecular and cortical microarchitecture measured by HR-pQCT and histomorphometry in patients with chronic kidney disease

• Published in: Bone (New York, N.Y.) Vol. 116; pp. 215 - 220
• Main Authors: Ramalho, J., Marques, I.D.B., Hans, Didier, Dempster, David, Zhou, Hua, Patel, Parth, Pereira, R.M.R., Jorgetti, V., Moyses, R.M.A., Nickolas, Thomas L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2018
• Subjects: Absorptiometry, Photon; Bone histomorphometry; Bone QCT/microCT; Cancellous Bone - diagnostic imaging; Cancellous Bone - pathology; Cortical Bone - diagnostic imaging; Cortical Bone - pathology; DXA; Female; Fracture risk assessment; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; Renal Insufficiency, Chronic - diagnostic imaging; Renal Insufficiency, Chronic - pathology; Statistics, Nonparametric; Bone histomorphometry; Bone QCT/microCT; DXA; Fracture risk assessment
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2018.08.006

The trabecular bone score (TBS) is a novel tool using grayscale variograms of the lumbar spine bone mineral density (BMD) to assess trabecular bone microarchitecture. Studies in patients with chronic kidney disease (CKD) suggest it may be helpful in assessing fracture risk. However, TBS has not been validated as a measure of trabecular architecture against transiliac bone biopsy with histomorphometry in CKD patients. We hypothesized that TBS would reflect trabecular architecture at the iliac crest in CKD patients.
We obtained tetracycline double labeled transiliac crest bone biopsy, areal BMD of the spine, total hip, femoral neck (FN) and spine TBS by dual energy X-ray absorptiometry (DXA), and cortical and trabecular volumetric density and microarchitecture by high resolution peripheral quantitative computed tomography (HR-pQCT) in CKD patients from two centers: twenty-two patients from Columbia University Medical Center, USA and thirty patients from Hospital das Clinicas – Universidade de São Paulo, Brazil. Two patients were excluded for outlier status. Univariate and multivariate relationships between TBS and measures from DXA, HR-pQCT and histomorphometry were determined.
Patients were 50.2 ± 15.8 years old, 23 (46%) were men, and 33 (66%) were on dialysis. TBS was <1.31 in 21 (42%) patients and 22%, 14% and 10% had T-scores ≤ −2.5 at spine, FN and total hip respectively. In univariate regression, TBS was significantly associated with trabecular bone volume (BV/TV), trabecular width (Tb.Wi), trabecular spacing, cortical width but not with trabecular number or cortical porosity. FN Z-score and height were also associated with cancellous BV/TV and Tb.Wi, In multivariate analysis, TBS remained an independent predictor of BV/TV and Tb.Wi. There were no relationships between TBS and dynamic parameters from histomorphometry.
These data suggest that TBS reflected trabecular microarchitecture and cortical width measured by bone biopsy in CKD patients. Future studies should address its utility in the identification of CKD patients who may benefit from fracture prevention strategies.
•TBS reflected trabecular bone volume, width and spacing and cortical width from histomorphometry.•Trabecular bone volume was lower in patients with TBS < compared ≥1.31.•TBS was not correlated with dynamic formation parameters from histomorphometry.