@article{a491f4b37e5143069bc6156954fd93a1,
title = "Trabecular Bone Score Reference Values for Children and Adolescents According to Age, Sex, and Ancestry",
abstract = "Trabecular bone score (TBS) is used for fracture prediction in adults, but its utility in children is limited by absence of appropriate reference values. We aimed to develop reference ranges for TBS by age, sex, and population ancestry for youth ages 5 to 20 years. We also investigated the association between height, body mass index (BMI), and TBS, agreement between TBS and lumbar spine areal bone mineral density (aBMD) and bone mineral apparent density (BMAD) Z-scores, tracking of TBS Z-scores over time, and precision of TBS measurements. We performed secondary analysis of spine dual-energy X-ray absorptiometry (DXA) scans from the Bone Mineral Density in Childhood Study (BMDCS), a mixed longitudinal cohort of healthy children (n = 2014) evaluated at five US centers. TBS was derived using a dedicated TBS algorithm accounting for tissue thickness rather than BMI. TBS increased only during ages corresponding to pubertal development with an earlier increase in females than males. There were no differences in TBS between African Americans and non-African Americans. We provide sex-specific TBS reference ranges and LMS values for calculation of TBS Z-scores by age and means and SD for calculation of Z-scores by pubertal stage. TBS Z-scores were positively associated with height Z-scores at some ages. TBS Z-scores explained only 27% and 17% of the variance of spine aBMD and BMAD Z-scores. Tracking of TBS Z-scores over 6 years was lower (r = 0.47) than for aBMD or BMAD Z-scores (r = 0.74 to 0.79), and precision error of TBS (2.87%) was greater than for aBMD (0.85%) and BMAD (1.22%). In sum, TBS Z-scores provide information distinct from spine aBMD and BMAD Z-scores. Our robust reference ranges for TBS in a well-characterized pediatric cohort and precision error estimates provide essential tools for clinical assessment using TBS and determination of its value in predicting bone fragility in childhood and adolescence.",
author = "Kalkwarf, {Heidi J.} and Shepherd, {John A.} and Didier Hans and {Gonzalez Rodriguez}, Elena and Kindler, {Joseph M.} and Lappe, {Joan M.} and Sharon Oberfield and Winer, {Karen K.} and Zemel, {Babette S.}",
note = "Funding Information: JAS has received investigator‐initiated grants from Hologic, Inc. and General Electric. DH is co‐owner of the TBS patent and has ownership shares and a position at Medimaps group. All other authors state that they have no conflicts of interest. Funding Information: This work was funded by the National Institute of Child Health and Human Development (NICHD) contracts NO1-HD-1-3228, NO1-HD-1-3329, NO1-HD-1-3330, NO1-HD-1-3331, NO1-HD-1-3332, and NO1-HD-1-3333, and grant R01 HD100406, and the Clinical and Translational Research Center grants 5-MO1-RR-000240 and UL1 RR-026314. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We acknowledge the dedication and valuable contributions of Vicente Gilsanz, MD, the study staff, and the study participants who made this study possible. Authors? roles: HJK: conceptualization, data curation, formal analysis, funding acquisition, methodology, and writing?original draft. JAS: data curation, methodology, and writing?review & editing. DH: data curation, software, and writing?review & editing. EGR: writing?review & editing. JK: methodology and writing?review & editing. JML: data curation, funding acquisition, methodology, and writing?review & editing. SO: data curation, methodology, and writing?review & editing. KKW: conceptualization, data curation, funding acquisition, methodology, project administration, resources, and writing?review & editing. BSZ: conceptualization, data curation, formal analysis, funding acquisition, methodology, and writing?review & editing. Funding Information: This work was funded by the National Institute of Child Health and Human Development (NICHD) contracts NO1‐HD‐1‐3228, NO1‐HD‐1‐3329, NO1‐HD‐1‐3330, NO1‐HD‐1‐3331, NO1‐HD‐1‐3332, and NO1‐HD‐1‐3333, and grant R01 HD100406, and the Clinical and Translational Research Center grants 5‐MO1‐RR‐000240 and UL1 RR‐026314. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We acknowledge the dedication and valuable contributions of Vicente Gilsanz, MD, the study staff, and the study participants who made this study possible. Publisher Copyright: {\textcopyright} 2022 American Society for Bone and Mineral Research (ASBMR).",
year = "2022",
month = apr,
doi = "10.1002/jbmr.4520",
language = "English (US)",
volume = "37",
pages = "776--785",
journal = "Journal of Bone and Mineral Research",
issn = "0884-0431",
publisher = "Wiley-Blackwell",
number = "4",
}