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Abstract：
BACKGROUND: The study of BMD provides only partial information on bone health in patients undergoing TSH suppression therapy due to differentiated thyroid cancer (DTC). The trabecular bone score (TBS), a new parameter assessing bone microarchitecture, is proposed for studying bone in this context. This study aimed to analyze their long-term use in patients with DTC.
METHODS: Bone mineral density (BMD) was measured by dual X-ray densitometry (DXA) and TBS was assessed with iNsigth software (version 2.0, MediImaps, France) in 145 postmenopausal patients with DTC. Vertebral fractures (VFs) were identified using a semi-quantitative X-ray method.
RESULTS: The BMD at the end of this study did not differ from the initial measurement. However, the TBS decreased from 1.35 ± 0.1 to 1.27 ± 0.1 (p = 0.002). Increased levels of PTH, osteocalcin, and bone alkaline phosphatase (BAP) were observed, suggesting enhanced bone remodeling. There was an increase in the prevalence of osteoporosis and osteopenia (40.6% and 16.5% to 46.6% and 18.6%, respectively). The proportion of patients with partially degraded and totally degraded TBS increased from 31% and 15.1% to 48.9% and 24.8% by the end of this study. Among the 30 patients with VFs, there were no significant differences in age, body mass index (BMI), calcium intake, alcohol consumption, smoking, radioiodine, therapy, or thyroid parameters compared to those without VFs. The odds ratio for VFs increased with osteopenia (OR 2.63). Combining TBS with BMD did not improve discrimination.
CONCLUSIONS: The TBS decreased while the BMD remained unchanged. The percentage of patients with osteoporosis and osteopenia, whether partially degraded or totally degraded, increased by the end of this study. The predominant discordance was found in partially degraded microarchitectures, with a higher proportion of osteopenic patients compared to those with normal or osteoporotic bone density. The AUC of the combination of TBS and BMD did not enhance discrimination. TBS, radioactive iodine therapy, and sedentary lifestyle emerged as the main distinguishing factors for DTC patients with VFs.
METHODS: Bone mineral density (BMD) was measured by dual X-ray densitometry (DXA) and TBS was assessed with iNsigth software (version 2.0, MediImaps, France) in 145 postmenopausal patients with DTC. Vertebral fractures (VFs) were identified using a semi-quantitative X-ray method.
RESULTS: The BMD at the end of this study did not differ from the initial measurement. However, the TBS decreased from 1.35 ± 0.1 to 1.27 ± 0.1 (p = 0.002). Increased levels of PTH, osteocalcin, and bone alkaline phosphatase (BAP) were observed, suggesting enhanced bone remodeling. There was an increase in the prevalence of osteoporosis and osteopenia (40.6% and 16.5% to 46.6% and 18.6%, respectively). The proportion of patients with partially degraded and totally degraded TBS increased from 31% and 15.1% to 48.9% and 24.8% by the end of this study. Among the 30 patients with VFs, there were no significant differences in age, body mass index (BMI), calcium intake, alcohol consumption, smoking, radioiodine, therapy, or thyroid parameters compared to those without VFs. The odds ratio for VFs increased with osteopenia (OR 2.63). Combining TBS with BMD did not improve discrimination.
CONCLUSIONS: The TBS decreased while the BMD remained unchanged. The percentage of patients with osteoporosis and osteopenia, whether partially degraded or totally degraded, increased by the end of this study. The predominant discordance was found in partially degraded microarchitectures, with a higher proportion of osteopenic patients compared to those with normal or osteoporotic bone density. The AUC of the combination of TBS and BMD did not enhance discrimination. TBS, radioactive iodine therapy, and sedentary lifestyle emerged as the main distinguishing factors for DTC patients with VFs.
摘要：
背景：BMD研究仅提供了部分有关因分化型甲状腺癌（DTC）而接受TSH抑制治疗的患者骨骼健康的信息。骨小梁评分（TBS），评估骨微结构的新参数，建议在这种情况下研究骨骼。本研究旨在分析其在DTC患者中的长期使用情况。
方法：通过双X射线密度法（DXA）测量骨密度（BMD），并使用iNsigth软件评估TBS（版本2.0，MediImaps，法国）145名绝经后DTC患者。使用半定量X射线方法鉴定椎骨骨折（VFs）。
结果：本研究结束时的BMD与初始测量值没有差异。然而,TBS从1.35±0.1降至1.27±0.1(p=0.002)。PTH水平升高,骨钙蛋白，骨碱性磷酸酶(BAP),提示骨重建增强。骨质疏松症和骨量减少的患病率有所增加（40.6％和16.5％至46.6％和18.6％，分别)。到本研究结束时，部分降解和完全降解TBS的患者比例从31％和15.1％增加到48.9％和24.8％。在30例VFs患者中，在年龄上没有显著差异,体重指数（BMI），钙摄入量，酒精消费,吸烟,放射性碘，治疗,或甲状腺参数与没有VFs的参数相比。VFs的比值比随骨质减少而增加（OR2.63）。将TBS与BMD结合并不能改善辨别力。
结论：TBS降低，BMD保持不变。骨质疏松症和骨量减少患者的百分比，无论是部分降解还是完全降解，在本研究结束时增加。在部分退化的微体系结构中发现了主要的不一致，与正常或骨质疏松的骨密度相比，骨质疏松患者的比例更高。TBS和BMD的组合的AUC没有增强辨别。TBS,放射性碘治疗,久坐的生活方式成为DTC患者VFs的主要区别因素。
方法：通过双X射线密度法（DXA）测量骨密度（BMD），并使用iNsigth软件评估TBS（版本2.0，MediImaps，法国）145名绝经后DTC患者。使用半定量X射线方法鉴定椎骨骨折（VFs）。
结果：本研究结束时的BMD与初始测量值没有差异。然而,TBS从1.35±0.1降至1.27±0.1(p=0.002)。PTH水平升高,骨钙蛋白，骨碱性磷酸酶(BAP),提示骨重建增强。骨质疏松症和骨量减少的患病率有所增加（40.6％和16.5％至46.6％和18.6％，分别)。到本研究结束时，部分降解和完全降解TBS的患者比例从31％和15.1％增加到48.9％和24.8％。在30例VFs患者中，在年龄上没有显著差异,体重指数（BMI），钙摄入量，酒精消费,吸烟,放射性碘，治疗,或甲状腺参数与没有VFs的参数相比。VFs的比值比随骨质减少而增加（OR2.63）。将TBS与BMD结合并不能改善辨别力。
结论：TBS降低，BMD保持不变。骨质疏松症和骨量减少患者的百分比，无论是部分降解还是完全降解，在本研究结束时增加。在部分退化的微体系结构中发现了主要的不一致，与正常或骨质疏松的骨密度相比，骨质疏松患者的比例更高。TBS和BMD的组合的AUC没有增强辨别。TBS,放射性碘治疗,久坐的生活方式成为DTC患者VFs的主要区别因素。
