Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: the Eastern European TBS study

The aim of the study was to assess the cli­nical performance of the model combining areal bone mineral density (aBMD) at spine and microarchitecural texture (TBS) for the detection of the osteoporo­tic fracture. The Eastern European Study is a multicenter study (Serbia, Bulgaria, Romania and Ukraine) evaluating the role of TBS in routine clinical practice as a complement to aBMD. All scans were acquired on Holo­gic Disco­very and GE Prodigy densitometers in a routine clinical manner. The additional clinical values of aBMD and TBS were analyzed using a two steps classification tree approach (aBMD followed by TBS tertiles) for all type of osteoporotic fracture (All-OP Fx). Sensitivity, specifi­city and accuracy of fracture detection as well as the Net Reclassification Index (NRI) were calculated. This study involves 1031 women subjects aged 45 and older recrui­ted in east European countries. Clinical centers were cross-calibrated in terms of BMD and TBS. As expe­cted, areal BMD (aBMD) at spine and TBS were only mo­derately correlated (r2 = 0.19). Prevalence rate for All-OP Fx was 26%. Subjects with fracture have significant lower TBS and aBMD than subjects without fracture (p < 0.01). TBS remains associated with the fracture even after adjustment for age and aBMD with an OR of 1.27 [1.07–1.51]. When using aBMD T-score of –2.5 and the lowest TBS tertile thre­sholds, both BMD and TBS were similar in terms of sensitivity (35 vs. 39%), specificity (78 vs. 80%) and accuracy (64 vs. 66%). aBMD and TBS combination, induced a significant improvement in sensitivity (+28%) and accuracy (+17%) compared to aBMD alone whereas a moderate improvement was observed in terms of specificity (+9%). The overall combination gain was 36% as expressed using the NRI. aBMD and TBS combination decrease significantly the number of subjects needed to diagnose from 7 for aBMD alone to 2. In a multicentre Eastern European cohort, we have shown that the use of TBS in addition to the aBMD permit to reclassified correctly more than one-third of the overall subjects. Furthermore, the number of subjects needed to diagnose fell to 2 subjects. Economical stu­dies have to be performed to evaluate the gain induced by the use of TBS for the healthcare system