TL;DR
It is suggested that visceral adiposity measured by opportunistic CT may serve as a potential biomarker for identifying postmenopausal women with osteopenia who are at an increased risk of fracture.
In postmenopausal women, higher BMI was associated with higher BMD but lower TBS, supporting a divergent relationship between densitometric findings and DXA-derived trabecular texture parameters, and suggesting that TBS may complement BMD in describing skeletal imaging status in overweight and obese women.
Background Obesity has been considered protective against osteoporosis due to its association with higher bone mineral density (BMD). However, metabolic dysfunction, particularly insulin resistance (IR), may compromise bone quality even with BMD preserved. Methods This retrospective cross-sectional study (n=254) included 153 individuals with severe obesity undergoing bariatric metabolic surgery and 101 age- and sex-matched non-obese controls. BMD and trabecular bone score (TBS) were measured using dualenergy X-ray absorptiometry. A subgroup of participants with obesity was further analyzed to examine associations between IR, assessed using the homeostasis model assessment of insulin resistance (HOMA-IR), and bone parameters. Results BMD was significantly higher in the obese group, indicating preserved bone mass in obesity. But the proportions of spine-hip Z-score discordance was significant higher in the obese group (P=0.001). TBS displayed sitespecific findings: TBS at L1 was significantly higher in the obese group (P=0.002), whereas no significant differences were observed at L2-L4. Partially degraded or degraded TBS were higher in the obese group (P=0.021). Among participants with obesity, TBS decreased progressively across HOMA-IR quartiles (P=0.043), whereas BMD remained stable. In multivariable regression, higher HOMA-IR was independently associated with lower TBS (β=-0.0025; 95% confidence interval, -0.0043 to -0.0006; P=0.015), although this association was attenuated by hemoglobin A1c adjustment. Conclusion Patients with obesity demonstrated site-specific reductions in trabecular bone quality, particularly in the lower lumbar spine compared with non-obese people. IR was independently and inversely associated with TBS, suggesting that metabolic dysfunction, not mechanical loading, influences bone fragility in obesity. TBS represents a valuable adjunct to BMD for assessing skeletal health in metabolically impaired obese populations.
The findings suggest that the clinical role of TBS in the assessment of pediatric bone health remains to be established, and that larger prospective studies are needed to clarify the clinical value of TBS for fracture risk assessment in pediatric autoimmune gastrointestinal diseases.
The trabecular bone score (TBS) provides complementary, indirect information on trabecular microarchitecture that may be independently impaired in SSc, and SSc patients exhibit significantly impaired bone microarchitecture compared with matched controls.
Osteoporosis is increasingly recognized as an immune-mediated condition (“immunoporosis”), yet data on bone health in adults with primary immunodeficiencies (PIDs) remain limited. Chronic immune dysregulation and multisystem complications in PIDs may adversely affect skeletal integrity, but bone microarchitecture and muscle mass have not been comprehensively evaluated in this population. The aim of our study was to assess bone mineral density (BMD), trabecular bone score (TBS), and muscle mass in adults with PIDs. Exploratory analyses examined associations between these measures and clinical features and the main peripheral blood lymphocyte subsets. In this single-center cross-sectional study, 61 adult patients with PIDs underwent dual-energy X-ray absorptiometry (DXA) of the lumbar spine, total hip, femoral neck, and whole body. TBS was derived from lumbar spine DXA images, and the appendicular lean mass index was calculated to assess muscle mass. Clinical characteristics and immunological parameters, including peripheral blood lymphocyte subsets, were analyzed in relation to skeletal outcomes. Based on age-appropriate DXA findings and clinical data, osteoporosis was diagnosed in 12 of 61 patients (19.7%). Three additional patients were diagnosed based on fragility fractures, increasing the overall prevalence to 15 of 61 (24.6%). Low BMD was more frequently detected at the hip than at the lumbar spine. Partially degraded or degraded TBS was observed in 15 of 61 patients (24.6%). Low muscle mass was identified in 17 of 61 patients (27.9%) and was associated with significantly lower BMD at all skeletal sites. Participants with bronchiectasis had lower femoral neck and total hip BMD and lower TBS, whereas those with enteropathy had lower BMD across all skeletal sites and lower TBS. Among participants eligible for T-score assessment (n = 15), NK-cell counts correlated positively with femoral neck (ρ = 0.63, p = 0.01) and total hip T-scores (ρ = 0.68, p < 0.01), and with TBS in the entire cohort (n = 61; ρ = 0.28, p = 0.03). CD4+, CD8+, and CD19+ cell counts were not associated with any evaluated densitometric parameters. In this cohort of adults with PIDs, reduced BMD and impaired TBS represented distinct, partially overlapping findings. Hip DXA appeared particularly informative, while TBS provided complementary information beyond BMD. These exploratory findings should be confirmed in prospective controlled studies.
It is indicated that trabecular microarchitecture deteriorates earlier and more rapidly with aging than bone mass loss captured by BMD, supporting the use of TBS as a complementary tool for evaluating skeletal health and fracture risk.