Major Advance In Bone Densitometry

Major Advance In Bone Densitometry

On November 11, 2013, we installed a new recently FDA approved software to our bone density machines which produces a report known as Trabecular Bone Score (TBS).  TBS creates a textured image from the spine DXA image.  It involves NO added radiation for you but analyzes the spine DXA image in a different way to enable us to better define your fracture risk.

In 1992, a Consensus Development Conference defined Osteoporosis as “…a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.”  Thus, it was recognized that fracture is the end-stage of the disease process and fracture risk is the most important factor to define in any individual patient.  In 1994, the World Health Organization (WHO) defined osteoporosis, operationally, for bone densitometry, as “normal,” “low bone mass (osteopenia)” and “osteoporosis.”  In 2001, another Consensus Development Conference further defined the goal of osteoporosis treatment is to increase Bone Strength which is the sum of Bone Density and Bone Quality.   Bone Density is measurable by DXA when it is acquired, analyzed and interpreted correctly.   Bone Quality is more difficult to measure but consists of factors such as mineralization (which can be approached by measuring your vitamin D level), bone remodeling (which can be approached by measuring blood and urine tests known as bone turnover markers), geometry (which we try to define by measuring hip axis length) and such factors as architecture and damage accumulation which have been difficult to define outside of the research laboratory where techniques such as micro-MRI and finite element analysis (FEA) can be utilized.

In 2008, the WHO released FRAX, a Fracture Risk Assessment Tool which employs Clinical Risk Factors, such as age, sex, ethnicity, height, weight, previous fracture, parental history of hip fracture, current smoking, current alcohol use, current use of glucocorticoids (steroids like prednisone or prednisolone), rheumatoid arthritis, secondary osteoporosis and femoral neck bone mineral density (BMD)  to define a ten year absolute fracture risk of hip fracture and major osteoporotic fracture risk (the sum of the risk of spine, hip, wrist and shoulder fracture).

The purpose of bone densitometry is 1) to diagnose osteoporosis via the WHO classification of osteoporosis, 2) to monitor serial changes in bone density over time and 3) to assess fracture risk.

Now, TBS adds the various factors of Bone Quality (described above) such as architecture and damage accumulation which have been available only by advanced research techniques to continue to improve the ability to assess fracture risk.  TBS is particularly sensitive to changes in trabecular bone, the most metabolically active bone compartment and, thus, to changes from disease and responses to medications.  TBS scans are interpreted from numbers that are developed from the image:  a TBS score > or = to 1.350 is “normal;” a TBS score of > 1.200 and < 1.350 is said to be “partially degraded;” and, a TBS score of < or = to 1.200 is said to be “degraded.”  At the present time, there is only a Caucasian female database.  With better evaluation of fracture risk, it is hoped that treatment recommendations can continue to evolve into a more accurate science for you.

Today, TBS is available at less than 10 centers in the US and only 3 clinical centers, none of them in California.

Thus, the Northern California Institute for Bone Health, Inc., because of the quality, experience and training of our personnel, remains the highest quality, most advanced bone density center that you can utilize to document your bone health.

® Northern California Institute for Bone Health-11-11-13  |