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Bone Microarchitecture Analysis Predicts Spine Fractures Independently of Bone Mineral Density: Presented at ASBMR

By John Otrompke

DENVER -- September 13, 2009 -- While measurement of bone mineral density by means of dual x-ray absorptiometry (DXA) may be the most commonly used method of predicting fracture risk, it misses or misidentifies some patients who are at increased risk of future bone fracture, according to a study presented at 31st Annual Meeting of the American Society for Bone and Mineral Research (ASBMR).

Because analyses based on bone mineral density do not take into account deteriorations in bone microarchitecture, other methods may be used to more effectively predict future fracture risk.

"When you have an overlap between friction and friction with or without bone mineral density, our method allows us to capture 42% of fractures misclassified by a bone mineral analysis," said Didier Hans, PhD, Lausanne University Hospital, Lausanne, Switzerland, at a poster presentation on September 12.

In the study, 22,234 women aged 50 years and older (mean age, 65 years) were identified in a database containing all clinical results for the province of Manitoba, Canada. Health records were then assessed for later fractures and the data was assessed by trabecular bone score (TBS), a novel technique designed in the last 2 years which extracts data from the DXA image analyses it in a 3-dimensional manner for bone micro-architecture.

The study was designed to prospectively evaluate the ability of lumbar spine TBS to predict clinical spine and other osteoporotic fractures. The women were followed-up for a median of 4.67 years.

Of the participants, 1.5% suffered a clinical spine fracture during the trial period, 1% had a hip fracture, and 5.7% suffered any fracture. The correlation between spine TBS and BMD was modest.

TBS was still a significant predictor of fracture risk after adjustment for comorbidities such as rheumatoid arthritis or prior osteoporotic fracture, body mass index, or prior antiresorptive therapy.

"Only 10% of the cases predicted by TBS were explained by bone mineral density," said Dr. Hans. "That's because the breakdown in bone microarchitecture is unrelated to BMD. That's important, because if a patient has poor bone microarchitecture with good BMD, a doctor might want to take a different treatment."

[Presentation title: Bone Micro-Architecture Assessed by TBS at the AP Spine Predicts Clinical Spine Fractures Independently of BMD in 22234 Women Aged 50 and Older: The Manitoba Prospective Study. Abstract SA0310]

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