Osteoporosis other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Osteoporosis other imaging findings

Finite element modelling (FEM)

Dual energy X-ray absorptiometery (DEXA, DXA)

Osteopenia - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 45995
Osteopenia with forearm measurement - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 45996
Osteoporosis - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 45997

Trabecular bone score (TBS)

  • Fracture risk assessment is very important in osteoporosis. It is based on couple of factors, include age, body weight, and some past medical history (e.g., smoking or alcohol use); and is measured by means of BMD assessment through DEXA scans.
  • The main limitation of using BMD as identifier of osteoporosis is that the BMD is focused on density and does not imply for microstructure or architecture of bones, at all. One of the most powerful methods to determine the microstructure is trabecular bone score (TBS) as a complementary method for DEXA.
  • TBS is a texture identifier of bones, measured and extracted from DEXA scan findings.
    1. Elevated TBS reflect the better microstructure of bones.
    2. Reduced levels of TBS is associated with higher risk of fracture.
  • The literature support the use of TBS along with BMD to predict the fracture risk more precisely.[11]
  • The major characteristics of TBS are as follow:
    1. TBS is reduced in postmenopausal women
    2. TBS is reduced in men with previous osteoporotic fractures
    3. TBS is complementary for lumbar spine DEXA
    4. TBS is reduced in women who experienced osteoporotic fractures (in whom DEXA was normal)
    5. TBS is the same as lumbar spine BMD in predicting fracture risk in postmenopausal women
    6. TBS is associated with fractures induced by bone mass loss[12]


References

  1. Messina C, Monaco CG, Ulivieri FM, Sardanelli F, Sconfienza LM (2016). "Dual-energy X-ray absorptiometry body composition in patients with secondary osteoporosis". Eur J Radiol. 85 (8): 1493–8. doi:10.1016/j.ejrad.2016.03.018. PMID 27048946.
  2. Seeman E (1998). "Growth in bone mass and size--are racial and gender differences in bone mineral density more apparent than real?". J. Clin. Endocrinol. Metab. 83 (5): 1414–9. doi:10.1210/jcem.83.5.4844. PMID 9589631.
  3. Black DM, Bouxsein ML, Marshall LM, Cummings SR, Lang TF, Cauley JA, Ensrud KE, Nielson CM, Orwoll ES (2008). "Proximal femoral structure and the prediction of hip fracture in men: a large prospective study using QCT". J. Bone Miner. Res. 23 (8): 1326–33. doi:10.1359/jbmr.080316. PMC 2680175. PMID 18348697.
  4. Cummings SR, Bates D, Black DM (2002). "Clinical use of bone densitometry: scientific review". JAMA. 288 (15): 1889–97. PMID 12377088.
  5. Lorente-Ramos R, Azpeitia-Armán J, Muñoz-Hernández A, García-Gómez JM, Díez-Martínez P, Grande-Bárez M (2011). "Dual-energy x-ray absorptiometry in the diagnosis of osteoporosis: a practical guide". AJR Am J Roentgenol. 196 (4): 897–904. doi:10.2214/AJR.10.5416. PMID 21427343.
  6. Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S (2008). "Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference". J Clin Densitom. 11 (1): 75–91. doi:10.1016/j.jocd.2007.12.007. PMID 18442754.
  7. Baim S, Leonard MB, Bianchi ML, Hans DB, Kalkwarf HJ, Langman CB, Rauch F (2008). "Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Pediatric Position Development Conference". J Clin Densitom. 11 (1): 6–21. doi:10.1016/j.jocd.2007.12.002. PMID 18442749.
  8. "WHO IRIS: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis : report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]".
  9. Srinivasan B, Kopperdahl DL, Amin S, Atkinson EJ, Camp J, Robb RA, Riggs BL, Orwoll ES, Melton LJ, Keaveny TM, Khosla S (2012). "Relationship of femoral neck areal bone mineral density to volumetric bone mineral density, bone size, and femoral strength in men and women". Osteoporos Int. 23 (1): 155–62. doi:10.1007/s00198-011-1822-8. PMC 3640410. PMID 22057550.
  10. Jain RK, Vokes T (2017). "Dual-energy X-ray Absorptiometry". J Clin Densitom. doi:10.1016/j.jocd.2017.06.014. PMID 28716497.
  11. Shevroja E, Lamy O, Kohlmeier L, Koromani F, Rivadeneira F, Hans D (2017). "Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice". J Clin Densitom. doi:10.1016/j.jocd.2017.06.019. PMID 28734710.
  12. Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP (2014). "Trabecular bone score: a noninvasive analytical method based upon the DXA image". J. Bone Miner. Res. 29 (3): 518–30. doi:10.1002/jbmr.2176. PMID 24443324.

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