Trabecular bone score and bone metabolism markers in middle-aged and older female patients with distal radius fractures.

BACKGROUND

Trabecular bone score (TBS) is a textural analysis of lumbar spine dual-energy X-ray absorptiometry (DXA) data that reflects bone microstructure and predicts fracture risk independent of DXA. This study evaluated TBS in distal radius fractures (DRF) patients, an initial manifestation of osteoporotic fractures.

METHODOLOGY: Fifty-eight female DRF patients (mean age, 73) who underwent DXA and TBS were included. Low-TBS was defined as ≤1.230 based on Japanese reference data. TBS data from 47 female knee osteoarthritis patients (mean age, 77) undergoing total knee arthroplasty (TKA) served as controls. Osteoporosis was defined as ≤-2.5 SD of T-score on DXA. Correlations between TBS and clinical parameters (age, BMI, and medical history), blood markers (calcium, magnesium, TRACP-5b, osteocalcin, PTH-intact, tP1NP, and 25OHD), and DXA were analyzed.

RESULTS

The mean TBS in DRF patients was 1.285±0.077, significantly lower than in TKA patients (1.325±0.084, p < 0.05). The prevalence of low-TBS in DRF patients (20.7%) was lower than DXA-defined osteoporosis (lumbar spine=44.8%; femoral neck=77.2%; total hip=43.9%, p < 0.05). TBS value correlated positively with DXA but negatively with age. Low-TBS patients with exhibited reduced calcium levels, elevated PTH-intact, increased renal dysfunction, and more fragility fractures (p < 0.05). Notably, 50% of low-TBS patients showed no osteoporosis on lumbar spine DXA, a finding associated with lower TRACP-5b, osteocalcin, and tP1NP levels.

CONCLUSIONS

TBS in DRF was associated with age, DXA, renal dysfunction, fragility fractures, and serum calcium and PTH-intact levels. However, low-TBS was less prevalent than DXA-defined osteoporosis. Discrepancies between TBS and DXA may reflect low bone-turnover osteoporosis.