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Fracture Discrimination by Combined Bone Mineral Density (BMD) and Microarchitectural Texture Analysis

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Abstract

The use of bone mineral density (BMD) for fracture discrimination may be improved by considering bone microarchitecture. Texture parameters such as trabecular bone score (TBS) or mean Hurst parameter (H) could help to find women who are at high risk of fracture in the non-osteoporotic group. The purpose of this study was to combine BMD and microarchitectural texture parameters (spine TBS and calcaneus H) for the detection of osteoporotic fractures. Two hundred and fifty five women had a lumbar spine (LS), total hip (TH), and femoral neck (FN) DXA. Additionally, texture analyses were performed with TBS on spine DXA and with H on calcaneus radiographs. Seventy-nine women had prevalent fragility fractures. The association with fracture was evaluated by multivariate logistic regressions. The diagnostic value of each parameter alone and together was evaluated by odds ratios (OR). The area under curve (AUC) of the receiver operating characteristics (ROC) were assessed in models including BMD, H, and TBS. Women were also classified above and under the lowest tertile of H or TBS according to their BMD status. Women with prevalent fracture were older and had lower TBS, H, LS-BMD, and TH-BMD than women without fracture. Age-adjusted ORs were 1.66, 1.70, and 1.93 for LS, FN, and TH-BMD, respectively. Both TBS and H remained significantly associated with fracture after adjustment for age and TH-BMD: OR 2.07 [1.43; 3.05] and 1.47 [1.04; 2.11], respectively. The addition of texture parameters in the multivariate models didn’t show a significant improvement of the ROC-AUC. However, women with normal or osteopenic BMD in the lowest range of TBS or H had significantly more fractures than women above the TBS or the H threshold. We have shown the potential interest of texture parameters such as TBS and H in addition to BMD to discriminate patients with or without osteoporotic fractures. However, their clinical added values should be evaluated relative to other risk factors.

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Acknowledgments

We are grateful to Farida Khacef and Nathalie Villequenault for their help in this study.

Conflict of interest

R. Winzenrieth is employed by the Med-Imaps group. J. Chaintreuil was employed at D3A Medical Systems when the work was initiated, then at the Med-Imaps group. D. Hans is CEO of the Med-Imaps group, co-owner of the TBS patent, and has corresponding ownership shares in the Med-Imaps group. J. Touvier, H. Johansson, H. Toumi, J. P. Roux, R. Jennane, and E. Lespessailles have declared no conflicts of interest.

Human and Animal Rights and Informed Consent

This study is in accordance with the Declaration of Helsinki and the International Conference on Harmonization of Good Clinical Practice Guidelines. Additionally, the protocol was approved by an independent regional ethics committee. All the patients and control women entered into the study after written informed consent.

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Authors and Affiliations

  1. I3MTO, EA4708, Université d’Orléans, 1, Rue Porte-Madeleine, Orléans, BP 2439, 45032 Cedex 1, France

    J. Touvier, H. Toumi, R. Jennane & E. Lespessailles

  2. R&D Department, Med-Imaps, Bordeaux, France

    R. Winzenrieth & J. Chaintreuil

  3. WHO Collaborating Center for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

    H. Johansson

  4. INSERM UMR 1033, Université de Lyon, Lyon, France

    J. P. Roux

  5. R&D Department, D3A, Rambouillet, France

    J. Chaintreuil

  6. Bone and Joint Department, Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland

    D. Hans

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  1. J. Touvier
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  2. R. Winzenrieth
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  8. D. Hans
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  9. E. Lespessailles
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Correspondence to J. Touvier.

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Touvier, J., Winzenrieth, R., Johansson, H. et al. Fracture Discrimination by Combined Bone Mineral Density (BMD) and Microarchitectural Texture Analysis. Calcif Tissue Int 96, 274–283 (2015). https://doi.org/10.1007/s00223-015-9952-1

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  • DOI: https://doi.org/10.1007/s00223-015-9952-1

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