The Added Value of Trabecular Bone Score in Evaluating Fracture Risk Among Polish Women Aged 40-76 Years

Objectives: Bone mineral density (BMD) assessment, the gold standard for diagnosing osteoporosis, does not account for bone quality and fracture susceptibility. Trabecular bone score (TBS) adds value to traditional densitometry. No studies have been conducted in the Polish population to date to confirm the association between TBS and fracture occurrence. This study aimed to evaluate the TBS derived from lumbar spine (L1-L4) dual-energy X-ray absorptiometry (DXA) scans in Polish women aged 40-76 years, both with and without osteoporotic fractures. The relationship between TBS, fracture risk (assessed by FRAX and TBS-adjusted FRAX), and BMD at the lumbar spine, femoral neck, and total hip was investigated. Methods: A total of 933 Caucasian women (760 without fracture and 173 with fracture) who underwent DXA examinations (Hologic Discovery A) between 2022 and 2024 were included. Lumbar TBS, BMD, and clinical fracture risk factors were analyzed, excluding subjects with scan artefacts or extreme BMI. Group differences were assessed using t-tests and chi-square tests. Pearson correlation was used to evaluate associations between TBS, age, and BMI. Logistic regression models assessed TBS and BMD as fracture discrimination, and model performance was compared using the Akaike Information Criterion (AIC) and the area under the receiver operating characteristic (ROC) curve (AUC). Results: TBS values were significantly lower in the fracture group (p < 0.001). TBS demonstrated negative correlations with age (r ≈ -0.36) and BMI (r ≈ -0.14). Low TBS values (≤1.23) were associated with the highest fracture prevalence (28.8%) and a threefold increased risk compared to high TBS (odds ratio = 3.0). Each one standard-deviation decrease in BMD or TBS T-score increased fracture risk by 56-67% (both p < 0.001). Models combining TBS and BMD improved discrimination, as indicated by higher AUC and lower AIC, with TBS remaining an independent predictor. In subgroups with osteopenia or osteoporosis, TBS retained statistical significance. Conclusions: TBS combined with BMD effectively discriminates fracture risk in Polish women and offers superior diagnostic accuracy compared to BMD alone. Integrating TBS with BMD enhances fracture accuracy. Routine assessment of TBS may improve clinical management of osteoporosis. Prospective studies are needed to confirm its long-term predictive value.