Abstract

Summary

Lumbar spine volumetric bone mineral density (BMD) measured using quantitative computed tomography (QCT) can discriminate between postmenopausal women with low areal BMD with and without vertebral fractures. QCT provides a 3D measure of BMD, excludes the vertebral posterior elements and accounts for bone size. This knowledge could contribute to effective treatment targeting of patients with low BMD.

Introduction

We evaluated the ability of lumbar spine bone mineral apparent density (BMAD), trabecular bone score (TBS) and volumetric bone mineral density (vBMD) to discriminate between postmenopausal women with low areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) with and without vertebral fractures. The discriminatory ability of lumbar spine aBMD was compared with that of BMAD, TBS and vBMD.

Methods

We studied three groups of postmenopausal women, i.e. group 1, aBMD T-score < − 1.0 and ≥ 1 vertebral fracture (n = 39); group 2, aBMD T-score < − 1.0 and no vertebral fracture, age- and aBMD-matched to group 1 (n = 34); group 3, aBMD score > − 1 and no vertebral fracture, age-matched to group 1 (n = 37). Lumbar spine aBMD was measured by DXA. BMAD was calculated using the DXA scan results. TBS was derived following DXA scan image reanalysis. Lumbar spine vBMD was assessed by quantitative computed tomography and Mindways Pro software. Differences in variables between groups 1, 2 and 3 were examined using general linear univariate modelling approaches. Area under the receiver operating characteristic (ROC) curve was calculated for BMAD, TBS and vBMD to determine the ability of lumbar spine measurement variables to discriminate between group 1 and group 2. A comparison of ROCs was performed.

Results

Lumbar spine BMAD and TBS measurement variables were similar for groups 1 and 2. However, vBMD was significantly lower in group 1 and could discriminate between those women with low aBMD with (group 1) and without vertebral fractures (group 2).

Conclusions

We conclude that lumbar spine vBMD may discriminate well between postmenopausal women with low aBMD with and without vertebral fractures as it provides a 3D measure of bone mineral density, excludes the posterior elements of the vertebrae and takes into account bone size. A unique feature of the SHATTER study is that groups 1 and 2 were matched for aBMD, thus our study findings are independent of aBMD. Furthermore, we observed that neither BMAD nor TBS could distinguish between women with low aBMD with and without vertebral fractures. The knowledge gained from the SHATTER study will influence clinical and therapeutic decision-making, thereby optimising the care of patients with and without vertebral and other fragility fractures.

中文翻译：

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定量计算机体层摄影术可区分脊柱骨矿物质密度低，椎骨骨折的绝经后妇女和脊椎骨矿物质密度低的绝经后妇女：SHATTER研究

摘要

概要

使用定量计算机体层摄影术（QCT）测量的腰椎体积骨矿物质密度（BMD）可以区分具有和不具有椎骨骨折的低面积BMD的绝经后妇女。QCT提供了BMD的3D测量，排除了椎骨后部元素并说明了骨大小。这些知识可能有助于针对BMD低的患者进行有效的治疗。

介绍

我们评估了腰椎骨矿物质表观密度（BMAD），小梁骨评分（TBS）和体积骨矿物质密度（vBMD）通过双能X射线来区分绝经后低面骨矿物质密度（aBMD）的妇女的能力骨密度测定法（DXA），有无椎体骨折。比较了腰椎aBMD与BMAD，TBS和vBMD的辨别能力。

方法

我们研究了三组绝经后妇女，即第1组，aBMD T分数<-1.0和≥1椎体骨折（n  = 39）。第2组，aBMD T评分<-1.0，无椎体骨折，年龄和aBMD与第1组匹配（n  = 34）；第3组，aBMD评分> − 1，无椎骨骨折，与第1组年龄匹配（n = 37）。腰椎aBMD通过DXA测量。使用DXA扫描结果计算BMAD。TBS是在DXA扫描图像重新分析后得出的。通过定量计算机体层摄影术和Mindways Pro软件评估腰椎vBMD。使用常规线性单变量建模方法检查了第1、2和3组之间变量的差异。计算BMAD，TBS和vBMD的接收器工作特征（ROC）曲线下的面积，以确定腰椎测量变量区分组1和组2的能力。比较了ROC。

结果

第1组和第2组的腰椎BMAD和TBS测量变量相似。但是，第1组的vBMD显着降低，并且可以区分那些aBMD较低的女性（第1组）和无椎体骨折（第2组）。

结论

我们得出的结论是，腰椎vBMD可以很好地区分具有和没有椎骨骨折的aBMD低的绝经后妇女，因为它提供了骨密度的3D测量，排除了椎骨的后部元素并考虑了骨大小。SHATTER研究的独特之处在于，第1组和第2组匹配aBMD，因此我们的研究结果与aBMD无关。此外，我们观察到BMAD和TBS都无法区分具有和没有椎骨骨折的aBMD低的女性。从SHATTER研究中获得的知识将影响临床和治疗决策，从而优化有无椎体骨折和其他脆性骨折的患者的护理。