Трабекулярный костный индекс при ревматических заболеваниях

Пациенты с иммуновоспалительными ревматическими заболеваниями (ИВРЗ) имеют высокий риск развития остеопороза (ОП) и остеопоротических переломов. Трабекулярный костный индекс (ТКИ) является относительно новым показателем качества кости, который независимо от минеральной плотности кости (МПК) определяет риск перелома. В исследованиях, посвященных изучению ТКИ, показано, что у пациентов с ИВРЗ его значения ниже, чем у здоровых лиц; при этом полученные данные свидетельствуют о том, что данный индекс при ряде ИВРЗ и особенно у пациентов, получающих глюкокортикоиды, позволяет прогнозировать переломы точнее, чем МПК или калькулятор оценки 10-летней вероятности остеопоротических переломов FRAX (Fracture Risk Assessment Tool). В немногочисленных исследованиях также отмечалось, что снижение ТКИ у пациентов с ревматоидным артритом, системной склеродермией и анкилозирующим спондилитом было связано с активностью заболевания. Однако в литературе мало данных о влиянии как терапии ИВРЗ, так и лечения ОП на величину ТКИ и прогнозирование переломов при этих заболеваниях. 

1. Rotta D, Fassio A, Rossini M, Giollo A, Viapiana O, Orsolini G, et al. Osteoporosis in inflammatory arthritides: New perspective on pathogenesis and treatment. Front Med (Lausanne). 2020;7:613720. doi: 10.3389/fmed.2020.613720

2. Adami G, Saag KG. Osteoporosis pathophysiology, epidemiology, and screening in rheumatoid arthritis. Curr Rheumatol Rep. 2019;21(7):34. doi: 10.1007/s11926-019-0836-7

3. Jin S, Hsieh E, Peng L, Yu C, Wang Y, Wu C, et al. Incidence of fractures among patients with rheumatoid arthritis: A systematic review and meta-analysis. Osteoporos Int. 2018;29(6):1263-1275. doi: 10.1007/s00198-018-4473-1

4. Omair MA, Pagnoux C, McDonald-Blumer H, Johnson SR. Low bone density in systemic sclerosis. A systematic review. J Rheumatol. 2013;40:1881-1890. doi: 10.3899/jrheum.130032

5. Ефремова АО, Торопцова НВ, Добровольская ОВ, Демин НВ, Никитинская ОА. Риск переломов и потребность в антиостеопоротическом лечении у больных системной склеродермией. Современная ревматология. 2021;15(1):32-37. doi: 10.14412/1996-7012-2021-1-32-37

6. Bultink IEM, Lems WF. Lupus and fractures. Curr Opin Rheumatol. 2016;28:426-432. doi: 10.1097/BOR.0000000000000290

7. Wang X, Yan S, Liu C, Xu Y, Wan L, Wang Y, et al. Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Osteoporos Int. 2016;27(4):1413-1423. doi: 10.1007/s00198-015-3449-7

8. van der Weijden MA, Claushuis TA, Nazari T, Lems WF, Dijkmans BA, van der Horst-Bruinsma IE. High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: A systematic review. Clin Rheumatol. 2012;31(11):1529-1535. doi: 10.1007/s10067-012-2018-0

9. Muñoz-Ortego J, Vestergaard P, Rubio JB, Wordsworth P, Judge A, Javaid MK, et al. Ankylosing spondylitis is associated with an increased risk of vertebral and nonvertebral clinical fractures: A population-based cohort study. J Bone Miner Res. 2014;29(8):1770-1776. doi: 10.1002/jbmr.2217

10. Белая ЖЕ, Белова КЮ, Бирюкова ЕВ, Дедов ИИ, Дзеранова ЛК, Драпкина ОМ, и др. Федеральные клинические рекомендации по диагностике, лечению и профилактике остеопороза. Остеопороз и остеопатии. 2021;24(2):4-47. doi: 10.14341/osteo12930

11. Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164(10):1108-1112. doi: 10.1001/archinte.164.10.1108

12. Richards C, Leslie WD. Trabecular bone score in rheumatic disease. Curr Rheumatol Rep. 2022;24(4):81-87. doi: 10.1007/s11926-022-01062-w

13. Лесняк ОМ (ред.). Остеопороз: руководство для врачей. М.:ГЭОТАР-Медиа;2016.

14. Цориев ТТ, Белая ЖЕ, Мельниченко ГА. Трабекулярный костный индекс – неинвазивный метод оценки качества костной ткани на основании рутинной двухэнергетической денситометрии. Перспективы использования в клинической практике. Альманах клинической медицины. 2016;44(4):462-476. doi: 10.18786/2072-0505-2016-44-4-462-476

15. McCloskey EV, Odén A, Harvey NC, Leslie WD, Hans D, Johansson H, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res. 2016;31(5):940-948. doi: 10.1002/jbmr.2734

16. Leslie WD, Majumdar SR, Morin SN, Hans D, Lix LM. Change in trabecular bone score (TBS) with antiresorptive therapy does not predict fracture in women: The Manitoba BMD cohort. J Bone Miner Res. 2017;32(3):618-623. doi: 10.1002/jbmr.3054

17. Senn C, Gunther B, Popp AW, Perrelet R, Lippuner K. Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: A 2-year open-label study. Osteoporos Int. 2014;25(7):1945-1951. doi: 10.1007/s00198-014-2703-8

18. Bilezikian JP, Hattersley G, Fitzpatrick LA, Harris AG, Shevroja E, Banks K, et al. Abaloparatide-SC improves trabecular microarchitecture as assessed by trabecular bone score (TBS): A 24-week randomized clinical trial. Osteoporos Int. 2018;29(2):323-328. doi: 10.1007/s00198-017-4304-9

19. Krohn K, Schwartz EN, Chung YS, Lewiecki EM. Dual-energy X-ray absorptiometry monitoring with trabecular bone score: 2019 ISCD official position. J Clin Densitom. 2019;22(4):501-505. doi: 101016/j.jocd.2019.07.006

20. Leslie WD, Krieg MA, Hans D. Clinical factors associated with trabecular bone score. J Clin Densitom. 2013;16(3):374-379. doi: 101016/j.jocd.2013.01.006

21. Buehring B, Thomas J, Wittkämper T, Baraliakos X, Braun J. Evaluation of the trabecular bone score (TBS) in routine clinical care of patients with inflammatory rheumatic and non-inflammatory diseases: Correlation with conventional bone mineral density measurement and prevalence of vertebral fractures. Z Rheumatol. 2020;79(10):1067-1074. doi: 10.1007/s00393-020-00764-9

22. Bréban S, Briot K, Kolta S, Paternotte S, Ghazi M, Fechtenbaum J, et al. Identification of rheumatoid arthritis patients with vertebral fractures using bone mineral density and trabecular bone score. J Clin Densitom. 2012;15(3):260-266. doi: 10.1016/j.jocd.2012.01.007

23. Kim D, Cho SK, Kim JY, Choi YY, Sung YK. Association between trabecular bone score and risk factors for fractures in Korean female patients with rheumatoid arthritis. Mod Rheumatol. 2016;26(4):540-545. doi: 10.3109/14397595.2015.1101212

24. Choi YJ, Chung YS, Suh CH, Jung JY, Kim HA. Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore). 2017;96(45):e8661. doi: 10.1097/MD.0000000000008661

25. Tavassoli S, Rajaei A, Emam MM, Farsad F. Evaluating the valueadded of the trabecular bone score in patients with rheumatoid arthritis. Arch Iran Med. 2021;24(3):193-198. doi: 10.34172/aim.2021.30

26. Killinger Z, Gajdarova L, Kuzma M, Krajcovicova A, Brazdilova K, Jackuliak P, et al. Biologic treatment in comparison to methotrexate has positive effect on trabecular bone score in rheumatoid arthritis patients: 1-year follow-up. Acta Clin Belg. 2019;74(2):121-125. doi: 10.1080/17843286.2018.1512189

27. Toussirot E, Mourot L, Wendling D, Dumoulin G. Trabecular bone score in rheumatoid arthritis and ankylosing spondylitis and changes during long term treatment with TNF a blocking agents. J Bone Miner Res. 2012;27:381.

28. Ebina K, Hirao M, Hashimoto J, Hagihara K, Kashii M, Kitaguchi K, et al. Assessment of the effects of switching oral bisphosphonates to denosumab or daily teriparatide in patients with rheumatoid arthritis. J Bone Miner Metab. 2018;36(4):478-487. doi: 10.1007/s00774-017-0861-4

29. Koumakis E, Avouac J, Winzenrieth R, Toth E, Payet J, Kahan A, et al. Trabecular bone score in female patients with systemic sclerosis: comparison with rheumatoid arthritis and influence of glucocorticoid exposure. J Rheumatol. 2015;42(2):228-235. doi: 10.3899/jrheum.140752

30. Ruaro B, Casabella A, Paolino S, Pizzorni C, Alessandri E, Seriolo C, et al. Correlation between bone quality and microvascular damage in systemic sclerosis patients. Rheumatology (Oxford). 2018;57(9):1548-1554. doi: 10.1093/rheumatology/key130

31. Lescoat A, Leroy M, Coiffier G, Cazalets C, Belhomme N, Ballerie A, et al. Bone mineral density and trabecular bone score assessment in systemic sclerosis: A cross-sectional study. Joint Bone Spine. 2021;88(5):105214. doi: 10.1016/j.jbspin.2021.105214

32. Ruaro B, Casabella A, Paolino S, Alessandri E, Patané M, Gotelli E, et al. Trabecular bone score and bone quality in systemic lupus erythematosus patients. Front Med (Lausanne). 2020;7:574842. doi: 10.3389/fmed.2020.574842

33. Lai EL, Huang WN, Chen HH, Chen JP, Chen DY, Hsieh TY, et al. Degraded microarchitecture by low trabecular bone score is associated with prevalent vertebral fractures in patients with systemic lupus erythematosus. Arch Osteoporos. 2020;15(1):54. doi: 10.1007/s11657-020-00726-3

34. Palma-Sánchez D, Reyes García R, Haro Martínez A, Moreno Ramos M, Linares Ferrando LF. Is the trabecular bone score useful for assessing bone quality in patients with axial spondyloarthritis and syndesmophytes? Rev Clin Esp (Barc). 2020;220(2):94-99. doi: 10.1016/j.rce.2019.05.005

35. Boussoualim K, Amouzougan A, Pallot-Prades B, Denarié D, Collet P, Marotte H, et al. Evaluation of bone quality with trabecular bone score in active spondyloarthritis. Joint Bone Spine. 2018;85(6):727-731. doi: 10.1016/j.jbspin.2018.02.006

36. Kang KY, Goo HY, Park SH, Hong YS. Trabecular bone score as an assessment tool to identify the risk of osteoporosis in axial spondyloarthritis: A case-control study. Rheumatology (Oxford). 2018;57(3):462-469. doi: 10.1093/rheumatology/kex377

37. Żuchowski P, Dura M, Jeka D, Waszczak-Jeka M. The applicability of trabecular bone score for osteoporosis diagnosis in ankylosing spondylitis. Rheumatol Int. 2022;42(5):839-846. doi: 10.1007/s00296-022-05109-0

38. Nam SW, Sung YK, Kim D, Cho SK, Song Y, Choi YY, et al. The usefulness of trabecular bone score in patients with ankylosing spondylitis. Korean J Intern Med. 2021;36(5):1211-1220. doi: 10.3904/kjim.2020.065

39. Richards C, Hans D, Leslie WD. Trabecular bone score (TBS) predicts fracture in ankylosing spondylitis: The Manitoba BMD Registry. J Clin Densitom. 2020;23(4):543-538. doi: 10.1016/j.jocd.2020.01.003

40. Jung JY, Han SH, Hong YS, Park SH, Ju JH, Kang KY. Inflammation on spinal magnetic resonance imaging is associated with poor bone quality in patients with ankylosing spondylitis. Mod Rheumatol. 2019;29(5):829-835. doi: 10.1080/14397595.2018.1510877

41. Kang KY, Ju JH, Park SH, Hong YS. Longitudinal association between trabecular bone loss and disease activity in axial spondyloarthritis: A 4-year prospective study. J Rheumatol. 2020;47(9):1330-1337. doi: 10.3899/jrheum.190749

42. Caparbo VF, Furlam P, Saad CGS, Alvarenga JC, Aubry-Rozier B, Hans D, et al. Assessing bone impairment in ankylosing spondylitis (AS) using the trabecular bone score (TBS) and highresolution peripheral quantitative computed tomography (HRpQCT). Bone. 2019;122:8-13. doi: 10.1016/j.bone.2019.01.024

43. Kang KY, Chung MK, Kim HN, Hong YS, Ju JH, Park SH. Severity of sacroiliitis and erythrocyte sedimentation rate are associated with a low trabecular bone score in young male patients with ankylosing spondylitis. J Rheumatol. 2018;45(3):349-356. doi: 10.3899/jrheum.170079

44. Колпаков КИ, Королёв МА, Летягина ЕА, Омельченко ВО. Изучение возможностей TBS в оценке структурного прогрессирования у молодых мужчин с анкилозирующим спондилитом. Остеопороз и остеопатии. 2020;23(2):75-76.

45. Jung JY, Kim MY, Hong YS, Park SH, Kang KY. Trabecular bone loss contributes to radiographic spinal progression in patients with axial spondyloarthritis. Semin Arthritis Rheum. 2020;50(5):827-833. doi: 10.1016/j.semarthrit.2020.07.009

46. Kolta S, Briot K, Fechtenbaum J, Paternotte S, Armbrecht G, Felsenberg D, et al. TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int. 2014;25(6):1759-1764. doi: 10.1007/s00198-014-2685-6

47. Kim HA, Lee HY, Jung JY, Suh CH, Chung YS, Choi YJ. Trabecular bone score is a useful parameter for the prediction of vertebral fractures in patients with polymyalgia rheumatica. J Clin Densitom. 2020;23(3):373-380. doi: 10.1016/j.jocd.2019.05.006

48. Lee KA, Kim JS, Kim HJ, Kim HS. Discriminative ability of trabecular bone score over bone mineral density for vertebral and fragility fracture in patients treated with long-term and low-dose glucocorticoid. Int J Rheum Dis. 2021;24(8):1053-1060. doi: 10.1111/1756-185X.14164

49. Nowakowska-Płaza A, Wroński J, Sudoł-Szopińska I, Głuszko P. Clinical utility of trabecular bone score (TBS) in fracture risk assessment of patients with rheumatic diseases treated with glucocorticoids. Horm Metab Res. 2021;53(8):499-503. doi: 10.1055/a-1528-7261

50. Florez H, Hernández-Rodríguez J, Muxi A, Carrasco JL, PrietoGonzález S, Cid MC, et al. Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis. Rheumatology (Oxford). 2020;59(7):1574-1580. doi: 10.1093/rheumatology/kez464

51. Martineau P, Leslie WD, Johansson H, Harvey NC, McCloskey EV, Hans D, et al. In which patients does lumbar spine trabecular bone score (TBS) have the largest effect? Bone. 2018;113:161-168. doi: 10.1016/j.bone.2018.05.026