TBS tool may help detect bone loss sooner in early Parkinson’s: Study
Trabecular bone score may be earlier predictor than gold standard BMD exam
Among people in the early stages of Parkinson’s disease, a tool called trabecular bone score, or TBS, may help detect bone loss sooner than the bone mineral density (BMD) exam that’s the current gold standard, according to researchers.
Specifically, the TBS tool may work better in assessing the degradation of bone’s fine architecture at an earlier point than BMD.
“These current data show that TBS, a parameter of bone quality (microarchitecture), might be an earlier predictor of bone involvement than BMD in [Parkinson’s] patients,” the researchers wrote in “Bone involvement in the early stages of Parkinson’s disease: a case-control study.” The work was published in the Journal of International Medical Research.
Studies have shown that people with Parkinson’s have low BMD, which is linked with osteoporosis — having weak or brittle bones — and a higher risk of bone fractures. BMD measures calcium and other minerals in bone.
However, bone health in the early stages of Parkinson’s disease is rarely assessed. Now, a team of researchers in Italy sought to learn more about the most effective ways to detect and predict bone loss.
TBS assesses bone microarchitecture to predict bone loss in patients
Using a technique called dual-energy X-ray absorptiometry, or DXA, measuring BMD is considered the gold standard for the diagnosis of osteoporosis and bone fracture. In this type of exam, an X-ray beam with two different energy levels is used to assess bone quantity.
TBS, a technique also based on DXA, reflects bone microarchitecture. It has been shown to better predict the risk of bone fractures in at-risk populations — such as people with type 2 diabetes and menopausal women.
In this study, the team from Naples evaluated bone health alterations using BMD and TBS. They then assessed the correlation of these measures with muscle performance both in individuals with early-stage Parkinson’s and in age-matched healthy participants, who served as controls.
Muscle performance was assessed by the short physical performance battery (SPPB), a balance and walking ability test that focuses on the lower extremities.
In total, the study included 13 patients, seven of them men, with a mean age of 65.8 years, as well as 13 age-matched controls, three of whom were men. All participants were followed at the University of Campania between January and March 2019.
Four patients (30.8%) and two controls (15.4%) already showed degradation of their bone microarchitecture, marked by a low TBS score (lower than 1.002). Fewer patients than controls showed partial degradation, defined by a TBS higher than 1.200 but lower than 1.3500 (23.1% vs. 38.5%).
[These findings] suggest that a complete bone assessment including TBS should be provided since the early management of osteoporosis based on an improved estimation of bone fragility should reduce the risk of fractures in patients with [Parkinson’s disease].
The researchers then compared participants with worse (SPPB score of eight or lower) versus better (SPPB score higher than eight) physical performance.
Parkinson’s patients with worse physical performance had significantly more degradation of their bone microarchitecture, with a TBS score of 1.18 versus 1.38. No differences were seen regarding BMD of the lower back and the left femoral neck, which is the top of the thigh bone. Femoral neck fractures, meaning those occurring in the hip, are among the most common injuries in adults older than 65.
The same analysis revealed no differences in TBS score and BMD measurements in the control group. Only body mass index, a measure of weight to height commonly used to assess body fat, differed significantly. Specifically, controls with better physical performance had a lower BMI.
The results were deemed preliminary and the researchers noted the small group of participants taking part in the study.
Nonetheless, these findings “suggest that a complete bone assessment including TBS should be provided since the early management of osteoporosis based on an improved estimation of bone fragility should reduce the risk of fractures in patients with [Parkinson’s disease],” the researchers concluded.
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