Korean J Intern Med.  2021 Sep;36(5):1211-1220. 10.3904/kjim.2020.065.

The usefulness of trabecular bone score in patients with ankylosing spondylitis

Affiliations
  • 1Department of Rheumatology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 2Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  • 3Division of Rheumatology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
  • 4Department of Radiology, Kok Hospital, Seongnam, Korea
  • 5Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
  • 6Department of Information Statistics, Yonsei University Mirae Campus, Wonju, Korea

Abstract

Backgrounds/Aims
This study was performed to reveal the usefulness of the trabecular bone score (TBS) in assessing bone strength in patients with ankylosing spondylitis (AS) in comparison with dual-energy X-ray absorptiometry (DXA) methods.
Methods
A total of 215 AS patients (75.8% male) were enrolled from a single university hospital in Korea. Demographic and clinical information were assessed. Patients completed X-rays of the cervical and lumbar spine (L-spine), and spinal ankyloses were quantified using the modified Stoke AS Spine Score (mSASSS). Hip, anteroposterior and lateral L-spine bone mineral density (BMD) and TBS were assessed by DXA methods. Clinical characteristics and bone strength measurement results were compared between male and female AS patients. The accuracy of each bone strength evaluation method in predicting Fracture Risk Assessment Tool (FRAX) scores indicating moderate or higher fracture risk was compared by receiver operating characteristic curves in patients aged ≥ 40 years. Correlations between each bone strength measurement method and mSASSS were examined.
Results
Male patients showed higher mSASSS and less prevalent peripheral joint involvement compared to female patients (p < 0.05). TBS, hip BMD, and L-spine lateral BMD showed comparably high areas under the curve (AUCs) for predicting FRAX-major osteoporotic fractures (MOF) ≥ 10% (AUC ranged 0.72 to 0.76). TBS negatively correlated with mSASSS in both male and female patients (p < 0.01).
Conclusions
TBS could predict the risk of MOF and is not influenced by spinal osteoproliferation in AS patients, even in those with advanced spinal changes.

Keyword

Bone; Osteoporosis; Ankylosing spondylitis
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