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.
Abstract
Background/Objectives: Children with autoimmune gastrointestinal diseases are at increased risk of impaired bone health due to chronic inflammation, nutritional deficiencies, growth disturbances, and treatment-related factors. While dual-energy X-ray absorptiometry (DXA) is the standard method for assessing bone mineral density (BMD), it provides limited information on bone microarchitecture. The trabecular bone score (TBS), derived from lumbar spine DXA images, has emerged as a complementary marker of bone quality. This study aimed to evaluate bone mass and TBS in children with autoimmune gastrointestinal diseases and to assess the clinical utility of TBS in comparison with children with a history of fractures and healthy controls. Methods: This study included 152 children aged 5–18 years: 45 with autoimmune gastrointestinal diseases (Crohn’s disease, ulcerative colitis, or celiac disease), 37 with a history of fractures, and 70 healthy controls. Anthropometric measurements, serum 25-hydroxyvitamin D [25(OH)D] concentrations, DXA-derived parameters, and TBS values were analyzed. Bone mineral density was assessed at the lumbar spine and total body less head (TBLH), with additional adjustment for height-for-age Z-score (HAZ). TBS values were expressed as sex- and pubertal stage-adjusted Z-scores. Results: Low bone mass (aBMDfor age Z-score ≤ −2) was observed in 30.3% of participants at TBLH and 11.1% at the lumbar spine, whereas a TBS Z-score ≤ −2 was identified in 5.2% of children. No significant differences in TBS or TBS Z-scores were found among the study groups. In multivariable analysis, fracture history was independently associated with lower absolute TBS, whereas no independent predictors of TBS Z-score were identified. Children with fractures had significantly lower HAZ-adjusted lumbar spine aBMD Z-scores than children with autoimmune gastrointestinal diseases and controls. TBS Z-scores correlated positively with age-adjusted and HAZ-adjusted aBMD values but showed no association with BMI or serum 25(OH)D concentrations. Conclusions: In this cross-sectional study, TBS did not distinguish children with autoimmune gastrointestinal diseases from those with fractures or healthy controls in the unadjusted analyses. Although TBS was associated with selected DXA-derived measures of bone mineral density and fracture history was independently associated with lower absolute TBS after multivariable adjustment, no independent predictors of TBS Z-score were identified. These findings suggest that the clinical role of TBS in the assessment of pediatric bone health remains to be established. Larger prospective studies are crucial to determine whether TBS provides clinically meaningful information complementary to conventional DXA for the assessment of skeletal health and fracture risk in children. Larger prospective studies are needed to clarify the clinical value of TBS for fracture risk assessment in pediatric autoimmune gastrointestinal diseases.
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.
A. Nowakowska-Płaza, J. Wroński, A. Zegadło et al.· Frontiers in Endocrinology· 0 citations
The study indicates that lower BHI SDS values are associated with increased fracture risk in children with classical OI and indicates that BHI may represent a clinically useful complementary tool for fracture risk stratification in young children with OI, particularly where DXA is unavailable or technically limited, including infancy.
Ruggero Lanzafame, Alistair D Calder, B. Crowe et al.· Journal of Clinical Endocrin...· 0 citations
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.
Nipaporn Intarasattakul, C. Pongchaiyakul, C. Foocharoen et al.· Journal of clinical densitom...· 0 citations
Reduced bone density is a common complication of chronic liver disease (CLD) in both adults and children. Factors contributing to bone mineral deficits are dependent on the pathophysiology and severity of the underlying liver disease. This case-control study aims to assess the bone mineral density in children (4-13 years old) suffering from CLD, using a dual-energy X-ray absorptiometry (DEXA) scan. The study was conducted in the Children’s Welfare Teaching Hospital (Baghdad, Iraq) from 1 November 2023 to 1 November 2024. Bone mineral density has been assessed by DEXA scan for 78 patients and controls in the pediatric age group. The mean Z-score was −0.44 among patients and 0.45 among the control group. This difference was statistically significant (p=0.02). According to the DEXA scan Z-scores, bone mineral density was significantly lower among children with CLD. Bone mineral density was correlated with alkaline phosphatase (ALP) and the duration of disease. Although there was a difference in Z-score levels across different disease types, this difference did not reach statistical significance.
M. Ibraheem, Jaafar Abdullah Hamzah· Euromediterranean Biomedical...· 0 citations
Adult-onset Still’s disease (AOSD) is a chronic systemic inflammatory disorder with sustained elevation of pro-inflammatory cytokines and frequent glucocorticoid use. Real-world data on bone health in AOSD remain scarce. This study aimed to evaluate bone health parameters and their associations with inflammatory markers in patients with AOSD. This cross-sectional study included 54 patients with AOSD who underwent dual-energy x-ray absorptiometry (DXA) at a tertiary referral center. Bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, and trabecular bone score (TBS) were assessed. Associations between C-reactive protein (CRP), ferritin, cumulative glucocorticoid dose, and bone parameters were analyzed using Spearman correlation, partial correlation adjusted for age, sex, and body mass index (BMI), and multivariable logistic regression. The mean age was 58.2 ± 12.0 years (79.6% female). Osteoporosis and osteopenia were present in 40.7% and 38.9%, respectively. TBS assessment (n = 52) revealed that 38 patients (73.1%) had normal microarchitecture (TBS > 1.350) and 14 (26.9%) had partially degraded microarchitecture (TBS 1.200–1.350). CRP showed a significant negative correlation with TBS (r = −0.445, P = .001), which remained significant after Bonferroni correction (adjusted P = .019) and after partial correlation adjusting for age, sex, and BMI (r = −0.336, P = .015). In multivariable logistic regression adjusted for age, sex, and BMI, CRP was independently associated with osteoporosis (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01–1.27, P = .039). In patients aged ≥ 50 years, log-transformed ferritin was independently associated with osteoporosis (OR 4.34, 95% CI 1.43–13.13, P = .009). Cumulative glucocorticoid dose was not significantly associated with bone parameters. These real-world data demonstrate a high burden of impaired bone health in patients with AOSD. CRP was independently associated with TBS and osteoporosis after adjustment for age, sex, and BMI, and ferritin was associated with osteoporosis in patients aged ≥50 years. These findings support the need for routine bone health screening in AOSD.
Y. Choi, Ji-Won Kim, Ju-Yang Jung et al.· Medicine· 0 citations
