Application of the Trabecular Bone Score in Clinical Practice

Area of Science:

• Osteoporosis research
• Radiology
• Bone health assessment

Background:

• Trabecular Bone Score (TBS) is a novel index of bone microarchitecture.
• It complements bone mineral density (BMD) by analyzing dual-energy X-ray absorptiometry (DXA) images.
• TBS has recently gained approval for clinical use in Korea.

Purpose of the Study:

• To provide a comprehensive review for optimizing the clinical application of TBS.
• To evaluate TBS as a predictor of osteoporotic fractures.
• To assess the utility of TBS in specific populations and treatment monitoring.

Main Methods:

• Systematic literature review of studies evaluating TBS.
• Analysis of TBS performance in predicting fractures in various demographics.
• Assessment of TBS utility in monitoring osteoporosis treatments.

Main Results:

• TBS is an independent predictor of osteoporotic fractures in postmenopausal women and men over 50.
• TBS is useful for monitoring anabolic agents but not antiresorptive agents.
• TBS provides fracture risk information not captured by BMD in postmenopausal women with type 2 diabetes.
• Limitations such as underestimation due to BMI and soft tissue thickness have been addressed in newer software versions.
• High precision error and low reproducibility remain limitations.

Conclusions:

• TBS is a valuable tool for assessing osteoporotic fracture risk beyond BMD.
• Its application in clinical practice can be optimized based on current evidence.
• Further research may be needed to address limitations in precision and reproducibility.