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Integrating TBS Into Your Clinical Practice.pdf

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Integrating TBS Into Your Clinical Practice.pdf

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Today’s current technology for diagnosing osteoporosis only measures bone density, which is only half of the World Health Organization's definition of osteoporosis. The full definition includes bone mineral density (BMD) and microarchitecture - trabecular bone score (TBS).

Today’s current technology for diagnosing osteoporosis only measures bone density, which is only half of the World Health Organization's definition of osteoporosis. The full definition includes bone mineral density (BMD) and microarchitecture - trabecular bone score (TBS).

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Integrating TBS Into Your Clinical Practice.pdf

  1. 1. USE OF TRABECULAR BONE SCORE (TBS), AN INDEX OF BONE QUALITY, IN DAILY CLINICAL PRACTICE Today & Tomorrow Structure matters Lynn Kohlmeier, MD Spokane Osteoporosis and Endocrinology, Director Strong Start DXA BMD and TBS Reports West Coast Strides For Strong Bones, Spokane CME TeleECHO, Medical Director Nonprofit Strides For Strong Bones, Director HypoPara Association Medical Advisory Board, Chief
  2. 2. DID YOU KNOW?  Osteoporotic Fractures Are Very Common! 1 fracture occurs every 3s worldwide! ~1 in 2 US women over age of 50 will break a bone!  Estimated cost/fracture is $14,000 or ~ $124B /year worldwide  Osteoporosis is Underdiagnosed and Undertreated! 70% of patients at risk for osteoporosis have not had a bone density test and have not been referred to a bone expert  40-50% of osteoporotic fractures occur in patients that do not meet criteria for osteoporosis by T-score  Osteoporosis medical treatment can reduce fracture risk by 40- 70%, improving Quality of Life and Independence!  Mortality 1 year after a hip fracture is 20 to 40%, with higher rates in men than in women National Osteoporosis Foundation. https://www.nof.org/patients/what-is-osteoporosis. Accessed January 5, 2021. https://josr-online.biomedcentral.com/articles/10.1186/s13018-019-1226-6
  3. 3. OSTEOPOROSIS IS… Systemic skeletal disease characterised by low bone mass and a micro-architectural deterioration of bone tissue…leading to fracture normal osteoporotic Historically, we have not had a clinical tool to speak to bone architecture Severe osteoporosis
  4. 4. BONE MINERAL DENSITY (BMD): is the Gold Standard FRACTURE RISK INCREASES with Decreasing BMD BUT… there’s MORE to Fracture Risk than just BMD! Fracture rate for 1000 people per year Number of fractured women 1.0 0.5 0.0 -0.5 -1.0 -1.5 -2.0 -2.5 -3.0 -3.5 Fracture rate Number of fractured women 0 10 20 30 40 50 0 100 200 300 400 Normal / Osteopenic Zone ? Bone Structure BMD 1 BMD 2 = Source: Siris et al. Arch Intern Med. 2004; 164:1108-1112 – The NORA cohort BMD T-score (-2.5 or less is used to diagnose osteoporosis)
  5. 5. MEDIMAPS GROUP IS.. ….. Software as a Medical Device (SaMD) company developing and selling bone micro-architecture software analytics solutions with artificial intelligence (AI) capabilities. Main technology framework is known as “Trabecular Bone Score” (TBS).
  6. 6. Trabecular Bone Score A higher TBS correlates with better bone architecture A lower TBS with worse bone architecture
  7. 7. TBS IS PROCESSED FROM DXA SCAN 2. BMD spine analysis 3. Software Processing 10s 4. TBS Analysis & Report fully automatic Seamlessly integrated into your workflow!
  8. 8. TBS: EXTENSIVE CLINICAL VALIDATION More than 1000 publications and 25+ guidelines  TBS is strongly correlated to 3D bone microarchitecture independent of bone mineral density (BMD)  TBS predicts fracture independent of BMD, clinical risk factors, and FRAX®  TBS helps fine tune assessment of fracture risk and medical treatment decisions in men and women  Secondary Osteoporosis such as Diabetes, Steroid or Glucocorticoid Use, Primary Hyperparathyroidism...  Osteopenia or Low Bone Density  Osteoarthritis (BMD can be inaccurate due to arthritis/osteophytes)  FRAX score close to intervention thresholds ISCD / BHOF ESCEO / IOF FRAX® SVGO, DVO, GRIO European Society for Clinical and Econiomic Aspects of Osteoorosis and Osteoarthritis (ESCEO), International Osteoporosis Foundation (IOF), Fracture Risk Assessment Tool (FRAX®), Bone Health Osteoporosis Foundation (BHOF) / International Society for Clinical. Densitometry (ISCD), Swiss Association against Osteoporosis (SVGO), Head Osteology Organization of Germany (DVO), Osteoporosis Research and Inforrmation Group (GRIO)
  9. 9. FRACTURE PREDICTION TBS Provides Fracture Risk Information Independent of BMD & Clinical Risk Factors • 33,352 women, Manitoba • 40-100 yrs, mean 63 yrs • Mean FU 4.7 yrs • Adjusted for FRAX clinical risk factors Adapted from Hans et al., JBMR 2011; Leslie et al., OI 2014 TBS and BMD are Complementary!
  10. 10. TBS & FRAX Adapted from WD. Leslie et al. Osteoporos Int. 2014 Jun 21 - McCloskey EV, et. al, Calcif Tissue Int, 2015: 96; 500-509 TBS and FRAX are Complementary TBS Results Are Used to Adjust FRAX
  11. 11. SECONDARY CAUSES OF BONE LOSS AND OSTEOPOROSIS TBS Bone Health Optimization Pre-operative Peri-operative Post-operative … Let’s Turn the Wheel! *Rare Bone Disease: HPP, Hypophosphatasia; XLH, X-Linked Hypophosphatemia; OI, Osteogenesis Imperfecta
  12. 12. DIABETES AND OSTEOPOROSIS: TBS IS IMPORTANT FOR THE ASSESSMENT OF FRACTURE RISK IN PATIENTS WITH DIABETES! Association Between TBS and Diabetes Diabetes vs Non-diabetes  Type II Diabetics in general had a lower TBS than Non- diabetics  In fact, patients with Prediabetes had a significantly lower TBS than normal subjects  In addition, TBS appears to be related to glycemic control in diabetic patients Ho-Pham & Nguyen, Osteoporosis Int. 2019 & IOF/ESCEO position paper on diabetes TBS adjusted FRAX improves assessment of fracture risk in patients with Diabetes, especially for women!
  13. 13. Fracture Risk Based on BMD and TBS HOW DO WE IMPLIMENT TBS INTO CLINICAL PRACTICE? FRACTURE RISK TBS SCORE RESULTS REFERENCE RANGE: > 1.310 Good or Normal bone quality or microarchitecture > 1.230 and < 1.310 Moderate or partially deteriorated bone quality or microarchitecture < 1.230 Poor or degraded bone quality or microarchitecture Normal for age? Secondary Cause for Bone Loss? Undiagnosed Fracture? Prevalent Fracture?
  14. 14. SHOULD WE TREAT? If a patient has low bone density or osteopenia AND a FRACTURE (MOF) they should be treated, irrespective of TBS & FRAX values ! 1. FRAX adjusted by TBS 2. BMD T-score adjusted for TBS
  15. 15. ALL IN ONE REPORT Fully automated conclusions for easy reporting  Seamlessly integrated into workflow in 10 seconds!
  16. 16. TBS IS REIMBURSED SINCE JANUARY 22 Independent CPT codes (category I)  $ 86.88 $ 86,88 $ 40 $ 2,64 $ 27,77 $ 9,59 1,21 0,29 0,84 0,08 To COMPLETE SLIDE…
  17. 17. Patient Journey throughout our product lines Prognostic rather than diagnostic 70% of patients not diagnosed timely 50% of DXA patients incompletely diagnosed 30% of implant revisions due to loosening & instability Mrs. Jones Mrs. Jones TBS AI TBS AI X-ray TBS Osteo DXA (Today) TBS Ortho Mrs. Jones had an X-ray of her knee because of pain and difficulty to walk. She felt young (63) so don’t feel concerned by osteoporosis yet. Mrs. Jones has a DXA performed to diagnose osteoporosis (today due to age and risk factors…, in the future, also when referred from Osteo X-ray) Mrs. Jones elects to have a knee replacement
  18. 18. BMD ALONE OR BMD + TBS? To conclude… Which DXA do you want? The one with only BMD or the blue one with both BMD & TBS
  19. 19. Even if you do not see it sometime… …structure really matters… Booth #3955 South Hall – Level 3 contact@medimapsgroup.com Lynn Kohlmeier, MD

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