Glucocorticoids and Trabecular Bone Score.

Area of Science:

• Bone biology and imaging analysis
• Endocrinology and metabolic bone disease
• Radiology and diagnostic imaging

Background:

• Trabecular Bone Score (TBS) evaluates bone micro-architecture using lumbar dual-energy X-ray absorptiometry (DXA) pixel data.
• TBS improves fracture prediction independently of DXA bone mineral density (BMD) and FRAX assessments.
• Glucocorticoids (GC) can be endogenous or exogenous, impacting bone health and micro-architecture.

Purpose of the Study:

• To review the relationship between TBS and Glucocorticoid (GC) exposure, both therapeutic and endogenous.
• To assess TBS's efficacy in identifying GC-induced bone damage and fractures.
• To explore TBS's role in managing patients with osteoporosis, diabetes, and adrenal conditions.

Main Methods:

• Narrative review of existing literature on TBS and Glucocorticoids.
• Analysis of TBS's correlation with GC dose, disease duration, and patient characteristics.
• Comparison of TBS and DXA-BMD in discriminating vertebral fractures.

Main Results:

• TBS is a superior discriminator of vertebral fractures in GC-induced osteoporosis compared to DXA-BMD.
• Inverse correlation observed between TBS and cumulative GC dose/disease duration.
• Low TBS values are associated with osteoporosis, diabetes mellitus, and GC use.

Conclusions:

• TBS is a valuable tool for assessing bone micro-architecture deterioration, especially in patients on GC therapy or with endogenous GC excess.
• Lumbar TBS can serve as a screening tool for menopausal women with type 2 diabetes mellitus.
• TBS provides complementary information to DXA-BMD for skeletal health evaluation in complex endocrine and metabolic conditions.