Vol 9, No 3 (2023)
Review paper
Published online: 2023-10-01

open access

Page views 141
Article views/downloads 145
Get Citation

Connect on Social Media

Connect on Social Media

The importance of bone mineral density and structure in fracture risk assessment of patients with rheumatoid arthritis and ankylosing spondylitis — perspectives

Daniel Dawid Jeka1
Rheumatology Forum 2023;9(3):145-148.

Abstract

Osteoporosis is a metabolic bone disease that is associated with an increased risk of fractures. The increased risk of fractures in osteoporosis occurs both due to a decrease in bone mineral density (BMD) and bone microarchitecture impairment. Dual-energy X-ray absorptiometry (DXA) is the current gold standard in osteoporosis diagnosis. In a DXA scan, fracture risk is only assessed based on a BMD measurement. This is sufficient to estimate true fracture risk in the general population. Unfortunately, in rheumatic diseases, such as rheumatoid arthritis (RA) or ankylosing spondylitis (AS), BMD often increases. However, the incidence of fractures in RA/AS patients is higher than in the general population. Put together, it becomes obvious that a BMD measurement alone is not sufficient to estimate the risk of fractures in rheumatic diseases. The increase in fracture incidence is strongly associated with bone microarchitecture impairment, which is not evaluated in a standard DXA scan. Therefore, it is necessary to introduce other diagnostic methods. One such assessment is the trabecular bone score (TBS). TBS is a numerical method that can be used during a DXA scan. It allows for a fracture risk assessment in patients with rheumatic diseases, much more accurately than just a BMD measurement.

Article available in PDF format

View PDF Download PDF file

References

  1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17(12): 1726–1733.
  2. Kanis JA, Norton N, Harvey NC, et al. SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos. 2021; 16(1): 82.
  3. Leslie WD, Shevroja E, Johansson H, et al. Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry. Osteoporos Int. 2018; 29(3): 751–758.
  4. Schneider DL, Bettencourt R, Barrett-Connor E. Clinical utility of spine bone density in elderly women. J Clin Densitom. 2006; 9(3): 255–260.
  5. Żuchowski P, Dura M, Jeka D, et al. The applicability of trabecular bone score for osteoporosis diagnosis in ankylosing spondylitis. Rheumatol Int. 2022; 42(5): 839–846.
  6. Wysham KD, Baker JF, Shoback DM. Osteoporosis and fractures in rheumatoid arthritis. Curr Opin Rheumatol. 2021; 33(3): 270–276.
  7. Li Na, Li XM, Xu Li, et al. Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women. Int J Endocrinol. 2013; 2013: 895474.
  8. Lin W, He C, Xie F, et al. Quantitative CT screening improved lumbar BMD evaluation in older patients compared to dual-energy X-ray absorptiometry. BMC Geriatr. 2023; 23(1): 231.
  9. Bousson V, Bergot C, Sutter B, et al. Scientific Committee of the Groupe de Recherche et d’Information sur les Ostéoporoses. Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects. Osteoporos Int. 2012; 23(5): 1489–1501.
  10. Pothuaud L, Carceller P, Hans D. Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture. Bone. 2008; 42(4): 775–787.
  11. Kanis JA, Melton LJ, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res. 1994; 9(8): 1137–1141.
  12. Silva BC, Leslie WD, Resch H, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res. 2014; 29(3): 518–530.
  13. Rajan R, Cherian KE, Kapoor N, et al. Trabecular Bone Score-An Emerging Tool in the Management of Osteoporosis. Indian J Endocrinol Metab. 2020; 24(3): 237–243.
  14. https://iscd.org/wp-content/uploads/2021/09/2019-Official-Positions-Adult-1.pdf (09.04.2023).
  15. Schacter GI, Leslie WD, Majumdar SR, et al. Clinical performance of an updated trabecular bone score (TBS) algorithm in men and women: the Manitoba BMD cohort. Osteoporos Int. 2017; 28(11): 3199–3203.
  16. Richards C, Leslie WD. Trabecular Bone Score in Rheumatic Disease. Curr Rheumatol Rep. 2022; 24(4): 81–87.
  17. Richards C, Hans D, Leslie WD. Trabecular Bone Score (TBS) Predicts Fracture in Ankylosing Spondylitis: The Manitoba BMD Registry. J Clin Densitom. 2020; 23(4): 543–548.
  18. Choi YJ, Chung YS, Suh CH, et al. Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore). 2017; 96(45): e8661.