Trabecular Bone Score: Where are we now?

Area of Science:

• Osteoporosis research
• Bone densitometry
• Radiology

Background:

• Trabecular Bone Score (TBS) is a recent index assessing bone microarchitecture from DXA scans.
• It is proposed as a surrogate for bone strength, aiding clinical practice.

Purpose of the Study:

• To review technical aspects of TBS, including correlations with microarchitecture and strength.
• To evaluate TBS's efficacy in fracture prediction and treatment monitoring.

Main Methods:

• Systematic review of studies correlating TBS with bone microarchitecture, strength, and clinical outcomes.
• Analysis of factors influencing TBS, such as age, BMI, and osteoarthritis.
• Assessment of TBS's performance in distinguishing fracture patients and predicting future fractures.

Main Results:

• TBS correlations with microarchitecture vary significantly and explain limited variance in vivo.
• TBS is reduced in patients with fragility fractures and shows discriminative ability for fracture risk.
• Combined analysis suggests TBS is a fracture predictor, but hip areal bone density remains superior in prospective studies.

Conclusions:

• TBS is a texture parameter reflecting bone microarchitecture, useful for fracture risk assessment.
• Current evidence does not support using TBS for monitoring patients undergoing anti-osteoporotic drug treatment.