Degenerative changes and trabecular bone score in patients with high bone mass by DXA

Reports of high bone mass (HBM) on routine DXA scanning are relatively common in clinical practice. The goal of this study is to compare a group of HBM individuals with a control group, assessing TBS and osteoarthritis rates differences between groups.

A database of DXA scans performed from 2019 to 2024 in a tertiary center in South Brazil was searched for patients with HBM, defined as femur or lumbar spine Z-score of ≥ 2.5. A control group with Z-score < 2.5 matched by age, sex, BMI and ethnicity was adopted, being both groups assessed for evident signs of osteoarthritis in DXA scans.

792 exams from 493 individuals revealed 65 individuals with HBM, from which 63 were paired with controls. Most patients were women (64.3%) and White (93.7%), with median age and BMI of 71 years-old and 27.9kg/m², respectively. Femoral and lumbar spine BMD was significantly different between groups, as well as Z-score, but L1-L4 TBS did not differ between groups (1.354 vs 1.376; p = 0.246). TBS was poorly correlated with hip and lumbar BMD in both groups, and such correlation was significant only in the control group. Signs of evident osteoarthritis were evenly distributed between groups in both lumbar and hip sites.

A complementary tool to assess bone health, TBS seems not to be different in patients with HBM, remaining suitable for such patients in bone global assessment. More studies are necessary to elucidate the real impact of such an instrument in HBM assessment and fracture risk stratification.