Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects

Area of Science:

• Osteoporosis Diagnosis
• Bone Densitometry
• Biomechanical Engineering

Background:

• Areal bone mineral density (BMD) via DXA is standard for osteoporosis diagnosis.
• DXA cannot assess cancellous bone microarchitecture, a key factor in bone strength.
• There is a clinical need for tools to evaluate bone microarchitecture.

Purpose of the Study:

• Introduce the Trabecular Bone Score (TBS) as a novel tool.
• Explain TBS computation principles and its correlation with microarchitecture.
• Discuss TBS's clinical utility in fracture identification and risk assessment.

Main Methods:

• TBS calculation based on gray-level variations in lumbar spine DXA images.
• Correlation analysis between TBS and bone microarchitectural parameters.
• Review of clinical studies on TBS for fracture risk prediction.

Main Results:

• TBS variations may reflect underlying bone microarchitecture.
• Clinical studies suggest TBS predicts fracture risk, even independently of BMD.
• Limitations of current TBS application are identified.

Conclusions:

• TBS highlights the inadequacy of BMD T-scores alone for fully capturing fracture risk.
• Current evidence is insufficient to confirm TBS reliably reflects patient-specific bone microarchitecture.
• Further studies are essential to establish TBS's clinical advantages and limitations for appropriate use.