Trabecular bone score

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The trabecular bone score is a measure of bone texture correlated with bone microarchitecture and a marker for the risk of osteoporosis. Introduced in 2008,[1] its main projected use is alongside measures of bone density in better predicting fracture risk in people with metabolic bone problems.

Need for a marker of microarchitecture

Microarchitecture of bone in health and in osteoporosis.

To diagnose

cortical bone thickness and increased porosity accompany trabecular bone loss, and in particular promote the fragility of the femoral neck. Osteoporotic bone is called "porous".[citation needed
]

Technical

Relative Risk of TBS expressed by standard deviation and compared with relative risks of major clinical risk factors for fracture

The trabecular bone score is a textural parameter that can be applied to DEXA, which quantifies the local variations in gray level. TBS is derived from the evaluation of the experimental variogram, obtained from the grayscale DEXA.[citation needed]

It was found that TBS is a reflection of the structural condition of the bone microarchitecture. TBS is strongly correlated with the number of

trabeculae and their connectivity and negatively with the space between trabeculae.[2][3] That is to say that a high TBS value means that microarchitecture bone is dense, well connected with little spaces between trabeculaes. Conversely, a low TBS value means that the microarchitecture of bone is incomplete and poorly connected with wide spaces between trabeculae.[4]

Clinical use

From a clinical standpoint, TBS provides:

  • assessment the risk of fracture;[5]
  • in combination with BMD, increase the number of patients at risk (correctly) identified;[5][6][7]
  • improvement the management of patients with secondary osteoporosis;[8]
  • follow-up of the evolution of microarchitecture of a patient over time;[4]
  • monitoring of the effect of anti-resorptive or anabolic.[citation needed]

All these studies have shown that TBS can be used as a clinical risk factor for osteoporotic fracture since it is reversible (with or without treatment), quantitative and independent of BMD. It should therefore be used as such in the same way that taking corticosteroids, rheumatoid arthritis or prevalent fracture after age 50.[citation needed]

The FRAX calculator has an option to include TBS for a TBS adjusted FRAX risk score. The calculated probabilities of fracture have been shown to be more accurate when computed including TBS.[9]

As TBS relies on measurement of soft tissue, it is considered unreliable in individuals with a

waist circumference.[11]

Further reading

Notes and references

  1. PMID 18234577
    .
  2. PMID 21724435
    .
  3. doi:10.1016/j.jocd.2011.02.056
    .
  4. ^
    PMID 21887701
    .
  5. ^
    PMID 19181553
    .
  6. S2CID 24345190
    .
  7. S2CID 5844264
    .
  8. PMID 22549969
    .
  9. ^ "What is TBS?". frax.shef.ac.uk. Archived from the original on 25 May 2023. Retrieved 25 May 2023.
  10. S2CID 201041419
    .
  11. PMC 10421136
    .
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