非骨密度DXA测量对骨折风险的预测——骨小梁评分(TBS):ISCD 2015官方共识(第四部分)

Fracture risk prediction by non-BMD DXA measures——trabecular bone score: the 2015 ISCD official positions

DXA测量骨密度(BMD)是诊断和治疗骨质疏松症的金标准,但是BMD只能解释60%～80%的骨强度,除BMD外还有众多其他骨骼特征与骨强度和骨折风险相关。且可以通过先进的影像技术获得这些骨骼特征。但是与传统的DXA相比较,这些技术的费用较高且获取不易。因此,在标准DXA测量基础和临床风险因素上,发展能够提升骨折预测的非侵入性检查技术来满足临床实践要求是一个重要的挑战。为此,骨小梁评分(trabecular bone score),一个从腰椎DXA图像衍生而来的灰阶结构指数被研究出来。ISCD专题工作组的目的是复习相关证据并提出如何在临床工作中使用TBS的建议。在临床中应用TBS来进行骨折风险评估、指导治疗、治疗监测和使用,以及在关于更高骨折风险的情况下如何使用TBS被一一列出。我们通过专家组对工作组的建议和证据进行了仔细的评审后推出了此官方立场。

Bone mineral density (BMD)measured by dual-energy X-ray absorptiometry (DXA)is the gold standard for the diagnosisand management of osteoporosis.However,BMD explains only 60%-80% of bone strength,anda number of skeletal features other than BMD.contribute to bone strength and fracture risk.Advanced imaging modalities can assess some of these skeletal feature's,but compared to standard DXA,these techniques have higher costs and limited accessibility.A major challenge,therefore, has been to incorporate in clinical practice a readily available,nouinvasive technology that permits improvement in fracture-risk prediction beyond that provided by the combination of standard DXA measurements and clinical risk factors.To this purpose, trabecular bone score (TBS),a gray-level textural index derived from the lumbar spine DXA image,has been investigated.The purpose of this International Society for Clinical Deusitometry task force was to review the evidence and develop recommendations on how to incorporate TBS in clinical practice.Clinical applications of TBS for fracture risk assessment,treatment initiation, monitoring of treatment,and use of TBS in special conditions related to greater fracture risk,were addressed.We present the official positions approved by an expert panel following careful review of the recommendations and evidence presented by the TBS task force.