Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions

Area of Science:

• Osteoporosis diagnostics and skeletal imaging analysis.
• Quantitative bone texture analysis for fracture risk assessment.

Background:

• Current osteoporosis diagnosis relies on bone mineral density (BMD) via DXA, but other skeletal factors influence fracture risk.
• Trabecular bone score (TBS), a texture analysis of DXA images, offers fracture prediction independent of BMD.

Approach:

• This task force reviewed existing evidence on TBS to develop clinical recommendations for its performance, reporting, and utilization.
• Recommendations focus on optimizing TBS integration into fracture risk assessment, particularly with FRAX®.

Key Points:

• TBS is most impactful in patients aged ≥40 nearing the FRAX® pharmacologic intervention threshold.
• Use TBS from L1-L4 vertebral levels (without exclusions) for adjusted FRAX® probabilities, even with degenerative changes or compression fractures.
• Avoid reporting TBS if significant artifacts are present; current TBS change monitoring is not recommended.

Conclusions:

• TBS provides valuable supplementary information for osteoporosis risk stratification beyond BMD.
• Standardized guidelines are crucial for consistent and effective clinical application of TBS.
• Future TBS algorithm updates aim to improve performance and address technical limitations.