INSIGHTS INTO THE RELATIONSHIP BETWEEN BONE MINERAL DENSITY AND TRABECULAR BONE SCORE AND THEIR PHYSIOLOGICAL CORRELATION WITH BODY MASS INDEX IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS
DOI:
https://doi.org/10.21272/eumj.2026;14(1);108-114Keywords:
Body mass index, Trabecular bone score, Bone mineral density, Osteoporosis, Postmenopausal womenAbstract
Background: People with a high body mass index (BMI), are somewhat protected against osteoporosis. Osteoporosis is a complex condition that primarily affects postmenopausal women and causes substantial morbidities and fatalities. Bone mineral density (BMD) evaluates just one of the many factors that affect bone. (TBS) is the trabecular bone score derives from DEXA scan images. It has been noted that there is a positive connection between BMD and a high body mass index (BMI).
Objective: This study aims to clarify for present any link between T-score, TBS, BMD, and BMI in postmenopausal women who had suffers from osteoporosis.
Methods: 566 postmenopausal women were chosen from the Alzahraa center of the Ibn-Albitar Private Hospital in Basrah, Iraq, for this study. Dual X-ray absorptiometry (DEXA) was used to measure the BMD of the L1–L4 vertebrae, and the TBS iNsight program was used to calculate the trabecular bone score from the same area of the participants' spine.
Results: In patients with osteoporosis and low bone density, there was a statistically significant negative connection between TBS and BMI. BMI and TBS did not substantially correlate in patients with normal T-scores (P > 0.01). Additionally, among participating individuals with osteoporosis, there was a noteworthy positive correlation between high BMI and TBS-T-score.
Conclusions: Higher BMI was linked to a lower TBS in patients with an aberrant T-score, despite the fact that it had a preventive effect against osteoporosis. However, among patients with normal T-scores, BMI had no discernible impact on TBS.
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References
Lorentzon M, Cummings SR. Osteoporosis: the evolution of a diagnosis. J Intern Med. 2015; 277(6):650–661. https://doi.org/10.1111/joim.12369
Kanis JA, Oden A, Johnell O. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporosis Int. 2001; 12(5):417–427. https://doi.org/10.1007/s001980170112
Pothuaud L, Carceller P, Hans D. Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture. Bone 2008; 42:775e87. https://doi.org/10.1016/j.bone.2007.11.018
Pisani P, Renna MD, Conversano F, et al. Major osteoporotic fragility fractures: risk factor updates and societal impact. World J Orthop. 2016;7(3):171–181. https://doi.org/10.5312/wjo.v7.i3.171
Lorentzon M, Nilsson AG, Johansson H. Extensive under treatment of osteoporosis in older Swedish women. Osteoporosis Int. 2019; 30(6):1297–1305. https://doi.org/10.1007/s00198-019-04872-4
Miller PD, Hattersley G, Riis BJ. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial. JAMA. 2016; 316(7):722–733. https://doi.org/10.1001/jama.2016.11136
Kanis JA, McCloskey EV, Johansson H. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013; 24(1):23–57. https://doi.org/10.1007/s00198-012-2074-y
Merlijn T, Swart KMA, van der Horst HE. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int. 2020; 31(2):251–257. https://doi.org/10.1007/s00198-019-05226-w
Vladyslav P, Del Rio L, Di Gregorio S, Michelet F, Dzerovych N, Musiienko A, et al. Is TBS different in healthy European Causcasion men and women? Creation of normative spine TBS data for men. J Clin Densitom 2015; 18:425. https://doi.org/10.22141/2224-1507.3.15.2014.79939
Kim JH, Choi HJ, Ku EJ, Hong AR, Kim KM, Kim SW, et al. Regional body fat depots differently affect bone microarchitecture in postmenopausal Korean women. Osteoporosis Int 2016;27: 1161e8. https://doi.org/10.1007/s00198-015-3329-1
Boutroy S, Hans D, Sornay-Rendu E, Vilayphiou N, Winzenrieth R, Chapurlat R. Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study. Osteoporosis Int 2013; 24:77e85. https://doi.org/10.1007/s00198-012-2188-2
Yanik B, Ayrim A, Ozol D, Koktener A, Gokmen D. Influence of obesity on bone mineral density in postmenopausal asthma patients undergoing treatment with inhaled corticosteroids. Clinics (Sao Paulo). 2009; 64(4): 313-8. https://doi.org/10.1590/s1807-59322009000400008
Kim YS, Han JJ, Lee J, Choi HS, Kim JH, Lee T. The correlation between bone mineral density/trabecular bone score and body mass index, height, and weight. Osteoporos Sarcopenia. 2017; 3:98-103. https://doi.org/10.1016/j.afos.2017.02.001
Siris, R. Adler, J. Bilezikian, M. Bolognese, B. Dawson-Hughes, B. Favus, M.J. et, al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporosis Int. (2014) (9): 1137-41. https://doi.org/10.1007/s00198-014-2655-z
Sridharan K, Cherian KE, Kurian ME, Asha HS, Paul TV, Kapoor N. Utility of anthropometric indicators in predicting osteoporosis in ambulant community dwelling rural postmenopausal women from southern India. Trop Dr. 2020;50:228–232. https://doi.org/10.1177/0049475520922769
Ripamonti C, Lisi L, Buffa A, Gnudi S, Caudarella R. The Trabecular Bone Score Predicts Spine Fragility Fractures in Postmenopausal Caucasian Women Without Osteoporosis Independently of Bone Mineral Density. Med Arch. 2018;72:46-50. https://doi.org/10.5455/medarh.2018.72.46-50
Park SY, Kim JH, Choi HJ, Ku EJ, Hong AR, Lee JH, et al. Longitudinal changes in bone mineral density and trabecular bone score in Korean adults: a community based prospective study. Arch Osteoporos 2020; 15:100. https://doi.org/10.1007/s11657-020-00731-6.
Torgutalp SS, Babayeva N, Kara OS, Ozkan O, Donmez G, Korkusuz F. Trabecular bone score of postmenopausal women is positively correlated with bone mineral density and negatively correlated with age and body mass index. Menopause. 2019;26(10):1166–70. https://doi.org/10.1097/GME.0000000000001375.
Mazzetti G, Berger C, Leslie WD, Hans D, Langsetmo L, Hanley DA, et al. Densitometer-specific differences in the correlation between body mass index and lumbar spine trabecular bone score. J Clin Densitom. 2017;20(2):233–8. https://doi.org/10.1016/j.jocd.2016.11.003
Padlina I, Gonzalez-Rodriguez E, Hans D, Metzger M, Stoll D, Aubry-Rozier B,et al. The lumbar spine age-related degenerative disease influences the BMD not the TBS: the Osteolaus cohort. Osteoporos Int. 2017;28(3):909 –15. https://doi.org/10.1007/s00198-016-3829-7
Amnuaywattakorn S, Sritara C, Utamakul C, Chamroonrat W, Kositwattanarerk A, Thamnirat K, et al. Simulated increased soft tissuethickness artefactually decreases trabecular bone score: a phantom study. J BMC Musculoskelet Disord. 2016; 17(1):17. https://doi.org/10.1186/s12891-016-0886-1
Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg MA. Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom 2011; 14: 302-12. https://doi.org/10.1016/j.jocd.2011.05.005
Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. Trabecular bone scores and lumbar spine bone mineral density of US adults: Comparison of relationships with demographic and body size variables. Osteoporos Int 2016; 27:2467e75 https://doi.org/10.1007/s00198-016-3550-6
Shayganfar A, Ebrahimian S, Masjedi M, Daryaei S. A study on bone mass density using dual energy X-ray absorptiometry: does high body mass index have protective effect on bone density in obese patients? J Res Med Sci2020; 25:4. https://doi.org/10.4103/jrms.jrms_1066_18
Bonaccorsi G, Cafarelli FP, Cervellati C, De Guio F, Greco P, Giganti M, et al. A new corrective model to evaluate TBS in obese post-menopausal women: A cross-sectional study. Aging Clin Exp Res 2020; 32:1303e8. https://doi.org/10.1007/s40520-019-01317-0
Leslie WD, Krieg MA, Hans D. Clinical factors associated with trabecular bone score. J Clin Densitom 2013; 16:374e9. https://doi.org/10.1016/j.jocd.2013.01.006
Romagnoli E, Lubrano C, Carnevale V, Costantini D, Nieddu L, Morano S, et al. Assessment of trabecular bone score (TBS) in overweight/obese men: effect of metabolic and anthropometric factors. Endocrine 2016; 54:342e7. https://doi.org/10.1007/s12020-016-0857-1
Muschitz C, Kocijan R, Haschka J, Pahr D, Kaider A, Pietschmann P, Hans D, Muschitz GK, Fahrleitner-Pammer A, Resch H. TBS reflects trabecular microarchitecture in premenopausal women and men with idiopathic osteoporosis and low-traumatic fractures. Bone. 2015; 79:259–266. https://doi.org/10.1016/j.bone.2015.06.007
Ulivieri FM, Silva BC, Sardanelli F, Hans D, Bilezikian JP, Caudarella R. Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine 2014; 47: 435–48. https://doi.org/10.1007/s12020-014-0280-4.
Shin YH, Gong HS, Lee KJ, Baek GH. Older age and higher body mass index are associated with a more degraded trabecular bone score compared to bone mineral density. J Clin Densitom. 2019; 22(2):266–71. https://doi.org/10.1016/j.jocd.2017.06.006.
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