Bone Structure, Quality, Architecture, Micro-Architecture
Difference in Spine TBS Between Men and Women: Real or Technical?

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Aims

Spine trabecular bone score (TBS) predicts osteoporotic and/or hip fractures in women and men independently of BMD and clinical risk factors. However, TBS software was optimized for women. Prodigy scanners (GE/Lunar) give average TBS values for men that are ∼13% lower than in women despite men having higher BMD and lower fracture risk. DXA image quality is degraded by soft tissue and also affects texture analysis. We hypothesized that soft tissue X-ray attenuation differences between men and

Methods

Spine (L1-4) DXA exams (Prodigy, GE/Lunar) were identified in a database containing all clinical results for the Province of Manitoba, Canada. Lumbar spine TBS (TBS iNsight®) was derived from each spine DXA examination blinded to clinical parameters. From this database we extracted two matched groups of men and women: Group 1 (matched for age, BMI, scan year, DXA scanner) and Group 2 (matched for spine tissue thickness measured from DXA). Mean group differences were analyzed using t-tests and

Results

Group 1 contained 3511 matched pairs of men and women, and Group 2 contained 3417 matched pairs of men and women (mean age 68 years, BMI ∼27 kg/m2). In Group 1 spine tissue thickness was 2.0 cm greater in men than women; in Group 2 there was only a small residual difference of 0.3 cm (see Figure). Spine tissue thickness showed a negative correlation with TBS in both women and men (p<0.001). In Group 1, mean spine TBS was 12.3% lower in men than women (p<0.001) while men had significantly

Conclusion

Lower mean spine TBS in men than women observed with GE/Lunar Prodigy scanners seems to be related to technical factors connected with how soft tissue affects image texture analysis at a given X-ray output. Additional studies are required to examine whether similar behaviors are seen at different age and scan mode as well as with other scanner configurations. The current version of TBS iNsight® software should not be used clinically to assess bone texture in men. Newer versions of software will

Disclosure of Interest

W. Leslie: None Declared, L. Lix: None Declared, S. Morin: None Declared, S. Majumdar: None Declared, D. Hans Patent holder of: Mediamps, Stock owner of: Medimaps

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