Endocrine Abstracts

Introduction: More than half of osteopenic patients suffer from fracture (Fx), but BMD osteopenia is usually not considered for treatment initiation. FRAX, tool that can identify patients with high Fx risk based on major risk factors, can be used as an interventional threshold. Past few years, trabecular bone score (TBS), the bone quality determinant, is a promising method identifying the high-risk patients according to degradation of trabecular bone.

Objective: Comparison of two methods, TBS and FRAX, in treatment consideration between postmenopausal women with osteopenia.

Methods: The group of osteopenic postmenopausal women were retrospectively analyzed. Using NOF cutoff values of 20% for major osteoporotic fracture and 3% for hip fracture were used to consider patients at high absolute 10 years risk of Fx. According to temporary consensus guidelines patients with BMD osteopenia+very low (degraded) TBS (<1.1) should be treated after secondary cause was excluded. TBS Insight tool was used to assess TBS derived from L-spine DXA scans.

Results: 157 postmenopausal women (mean age 65.9 years, BMI 26.7 kg/m², T-score: neck −1.2; L-spine 1.4, and TBS 1.24) were included. In total, by NOF cutoff 44 (28%) patients, who may be treated were identified. From that number 20 (12.7%) patients belonged to highly degraded TBS group. Another 32 (20.3%) patients with highly degraded TBS were identified in low risk FRAX group.

Conclusion: In the present study, the FRAX tool was able to identify additional 28% more patients in high fracture risk, which should be considered for treatment. From NOF high-risk group TBS identified 20 patients at increased risk of fracture and additional 32 patients from whole study group with degraded TBS who should be treated. According to this study, addition of TBS to FRAX brings novel info in identifying high Fx risk patients with osteopenia.