Medical Utility of Utilizing Lumbar Backbone Trabecular Bone Rating to Regulate Fracture Chance: The Manitoba BMD Cohort.
J Bone Miner Res. 2017 Jul;32(7):1568-1574
Authors: Martineau P, Leslie WD, Johansson H, Oden A, McCloskey EV, Hans D, Kanis JA
Decreased lumbar backbone trabecular bone rating (TBS), a dual-energy X-ray absorptiometry (DXA)-derived picture texture measurement, is a threat issue for main osteoporotic fracture (MOF) and hip fracture (HF) unbiased of 10-year fracture chance estimated utilizing FRAX. We decided how typically making use of the TBS adjustment to fracture chance altered remedy qualification. Utilizing a population-based registry containing all scientific DXA outcomes for Manitoba, Canada, we recognized 34,316 ladies with baseline backbone and hip DXA, FRAX-based fracture chance measurements (computed with femoral neck bone mineral density), lumbar backbone TBS, and minimal 5 years of remark (imply eight.7 years). Inhabitants-based well being companies information had been used to establish incident non-traumatic MOF and HF in 3503 and 945 ladies, respectively. Baseline MOF and HF chances had been estimated utilizing FRAX earlier than and after making use of the TBS adjustment. Threat recategorization was assessed utilizing web reclassification enchancment (NRI) for particular person FRAX-based intervention standards and three nationwide scientific follow pointers (CPGs) (US Nationwide Osteoporosis Basis, Osteoporosis Canada, and UK Nationwide Osteoporosis Guideline Group). General, proportions of ladies reclassified with the TBS adjustment to FRAX had been small (lower than 5%) with greater than 90% of the reclassification occurring near the intervention threshold. For girls near an intervention cut-off reclassification, charges ranged from 9.zero% to 17.9% and had been <1% in any other case. There was a small however vital enchancment in total NRI for all particular person FRAX-based intervention standards (vary zero.007 to zero.018) and all three nationwide CPGs (vary zero.008 to zero.011). NRI was bigger in ladies beneath age 65 years (as much as zero.056 for hip fracture). In abstract, a small however vital enchancment in MOF and HF threat evaluation was discovered by utilizing lumbar backbone TBS to regulate FRAX chance. An enchancment in threat reclassification was noticed for CPGs from three completely different nations, with nearly all the profit present in people near an intervention threshold. © 2017 American Society for Bone and Mineral Analysis. © 2017 American Society for Bone and Mineral Analysis.
PMID: 28276598 [PubMed – indexed for MEDLINE]