jbm > Volume 28(2); 2021 > Article
Kong, Hong, Kim, Kim, and Kim: Application of the Trabecular Bone Score in Clinical Practice


The trabecular bone score (TBS) was introduced as an indirect index of trabecular microarchitecture, complementary to bone mineral density (BMD), and is derived using the same dual energy X-ray absorptiometry images. Recently, it has been approved for clinical use in Korea. Therefore, we conducted a comprehensive review to optimize the use of TBS in clinical practice. The TBS is an independent predictor of osteoporotic fractures in postmenopausal women and men aged >50 years. The TBS is potentially useful in monitoring the skeletal effects of anabolic agents but not of antiresorptive agents. In postmenopausal women with type 2 diabetes mellitus, the TBS assesses osteoporotic fracture risk not captured by BMD. However, high body mass index and soft tissue thickness can cause underestimation of the TBS; however, this limitation has been improved in recent versions of the TBS software. However, a high precision error and low reproducibility limit the use of TBS. This review may provide information on the application of the TBS in clinical practice based on reliable evidence.


Bone mineral density (BMD) assessed using dual energy X-ray absorptiometry (DXA) plays a pivotal role in assessing fracture risk. However, more than 50% of fragility fractures occur in subjects with a normal or osteopenic range of BMD.[1] This observation implies that bone quality or microarchitecture is another determinant of bone strength as BMD accounts for only 60% to 70% of bone strength.[2] Therefore, interest in assessing the bone quality or bone microarchitecture has emerged. Several tools, such as quantitative computed tomography (QCT), high-resolution peripheral QCT, high-resolution magnetic resonance imaging, finite element analysis, and bone biopsy have been suggested.[3] However, these tools have several caveats, such as high cost, radiation exposure, invasiveness, and limited availability. Accordingly, a readily available and noninvasive bone quality assessment tool is needed to improve fracture risk assessment.
The trabecular bone score (TBS) was developed as another noninvasive imaging tool for assessing skeletal microstructure.[4] TBS is a textural index that evaluates gray-level variations in pixels in images of the lumbar spine, which is the same region of interest of the BMD derived from DXA (Fig. 1). On the projected 2-dimensional image of the 3-dimensional (3D) structure, the experimental variogram is calculated as the sum of the squared gray-level differences between pixels at a specific distance.[3] TBS is obtained from the slope of the log-log transformation of this experimental variogram.[3] High TBS values (unitless) indicate low-amplitude finely textured fluctuations.[5] Previous studies have shown that TBS is correlated with bone microarchitecture parameters such as trabecular number, trabecular thickness, connectivity, or spacing [4,6]; however, it is still unclear what exactly TBS represents.[5] Moreover, abdominal soft tissue thickness factitiously reduces TBS values, and the early version of the TBS generated lower TBS values for obese subjects and women. TBS developers upgraded the software to TBS version 4.0, which overcomes this regional soft tissue noise.[7] Recommended cut-offs in the literature are TBS >1.350 as normal; TBS between 1.200 and 1.350 as partially degraded microarchitecture; and TBS <1.200 as degraded microarchitecture.[8]
In 2012, TBS (TBS iNsight®; Med-Imaps, Pessac, France) was approved by the US Food and Drug Administration for use as a complement to DXA analysis for the assessment of fracture risk. In 2015 and 2019, the International Society for Clinical Densitometry (ISCD) published its official position regarding TBS as a non-BMD DXA measure for fracture risk prediction and monitoring.[3,9] Recently, TBS has also been approved for clinical use in Korea. At present, we have aimed to review the usefulness and limitations of TBS, and to provide valuable information on how to incorporate TBS in clinical practice.


1. TBS can be helpful in assessing vertebral, hip, and any major osteoporotic fracture risk in postmenopausal women, with further validation in the Korean population

In previous cross-sectional and prospective studies, TBS has been associated with osteoporotic fractures in postmenopausal women.[10-13] The most extensive prospective study was by Hans et al. [13] and involved the Manitoba cohort. During a mean follow-up of 4.7 years, the study reported that a decrease of 1 standard deviation (SD) in TBS was associated with a 1.22-, 1.28-, and 1.20-times increased risk of vertebral, hip, and any major osteoporotic fractures (MOF), respectively (95% confidence interval [CI], 1.10-1.34, 1.13-1.46, and 1.14-1.26, respectively). Moreover, the correlation between lumbar spine BMD and TBS was insignificant (r=0.32), while that between the lumbar spine and hip BMD was significant (r=0.72), suggesting that TBS and BMD may reflect different skeletal aspects. In another prospective study conducted in Japan, the odds ratio (OR) for vertebral fractures with 1 SD decrease in TBS was 1.98 (95% CI, 1.56-2.51) and remained significant (OR, 1.64; 95% CI, 1.25-2.15) after adjusting for BMD [14] in postmenopausal women. A combination of TBS and BMD in a single model significantly improved risk prediction accuracy than BMD alone (area under the curve [AUC], 0.73 vs. 0.673). The authors suggested that adding TBS improved the predictive ability of BMD than BMD alone.
In a meta-analysis of 17,809 participants in 14 prospective population-based cohorts, TBS adjusted for follow-up duration and age was significantly associated with MOF (gradient of risk [GR]; risk per SD of each parameter, 1.40; 95% CI, 1.30-1.52) in postmenopausal women. When additionally adjusted for Fracture Risk Assessment Tool (FRAX) 10-year probability of MOF, TBS remained an independent predictor (GR, 1.32; 95% CI, 1.24-1.41).[15] In this study, meaningful improvements in assessing the risk of MOF and hip fracture occurred when TBS was added to adjust FRAX probability. On the other hand, in a recent prospective study of 1,165 Korean women followed up over 7.5 years, BMD-adjusted FRAX and TBS-adjusted FRAX were similar in assessing MOF risk, based on Harrell’s C statistics.[16] Accordingly, in conjunction with the FRAX, TBS could improve fracture risk assessment in postmenopausal women and help guide treatment decisions; however, further validation studies in the Korean population are required. An online calculator that can include TBS and BMD values is available on the FRAX website (https://www.sheffield.ac.uk/FRAX/tool.aspx?lang=ko). A summary of cross-sectional and longitudinal studies on TBS and fracture risk in women are shown in Table 1.

2. TBS can be helpful in assessing hip and any major osteoporotic fracture risk in men aged >50 years, with further validation in the Korean population

As in postmenopausal women, TBS has been reported to be associated with osteoporotic fractures in men over 50 years old in cross-sectional and prospective studies.[15,17-19] In the Osteoporotic Fractures in Men Study (MrOS), among 5,863 American men aged 65 years and older, 448 and 181 men experienced major osteoporotic and hip fractures, respectively, over 10 years of follow-up.[19] As TBS decreased by 1 SD, the hazard ratio (HR) for MOFs increased to 1.27 (95% CI, 1.17-1.39), and the HR for hip fracture was 1.20 (95% CI, 1.05-1.39). Moreover, when TBS was added to the FRAX, 3.5% of men were correctly classified as MOF cases. The MrOS cohort study in Hong Kong reported that Chinese men with lower TBS had a higher risk of osteoporotic fracture (HR, 4.68; 95% CI, 2.11-10.41).[18] The predictive power for osteoporotic fractures was substantially improved by adding TBS to BMD; the AUC rose from 0.604 (0.562-0.646) to 0.666 (0.623-0.710), and sensitivity improved from 32.5% to 64.3%. In addition, in the Japanese population-based osteoporosis cohort study, men with MOFs had significantly lower TBS and higher FRAX scores than those without fractures.[20] In the study, TBS significantly improved the predictive power of FRAX in men over 50 years old (integrated discrimination improvement [IDI], 0.006; P=0.036; net reclassification index [NRI], 0.452; P=0.035; IDI and NRI are measurements for evaluating improvements in risk predictions). In the meta-analysis mentioned above, TBS adjusted for follow-up duration and age showed an association with MOF (GR, 1.50; 95% CI, 1.36-1.66) in men.[15] The association remained significant after FRAX 10-year probability was adjusted (GR, 1.35; 95% CI, 1.21-1.49). These studies confirmed an independent association between TBS and major osteoporotic and hip fractures in men, but as in postmenopausal women, further validation studies in Korean men are required. A summary of cross-sectional and longitudinal studies regarding TBS and fracture risk in men is shown in Table 2.


1. TBS should not be used alone to guide the initiation of treatment in clinical practice

2. TBS can be used along with BMD and FRAX to adjust for the FRAX-probability of fracture in postmenopausal women and men over 50 years old, with further validation in the Korean population

Currently, there is no evidence supporting the use of TBS alone to guide initiation of treatment, which has also been noted in the recent ISCD position statement.[3] A clinical threshold of TBS that can be used to initiate anti-osteoporotic medications has not yet been established.
TBS can be used to adjust for the FRAX-probability of fracture in association with FRAX and BMD. In the Manitoba registry from Canada including 33,352 women aged 40 to 100 years (mean age, 63; 1 or more MOF in 1,872 women over a mean of 4.7 years), each SD reduction in TBS was associated with an 18% and 23% increase in MOF and hip fracture risk, respectively, after adjusting for femoral neck BMD and clinical risk factors.[12] Based on this study, a TBS-adjusted FRAX model for MOF and hip fracture probability was derived and applied to the FRAX website from April 2014.[21] The impact of TBS adjustment was more marked in younger women and women with lower BMDs. Results from an individual-level meta-analysis of 17,809 men and women from 14 prospective cohorts (mean, 6.1 years of follow-up) showed a small increase in the GR of MOF (1.76 vs. 1.70) and hip fracture (2.25 vs. 2.22) when FRAX was adjusted with TBS, and was similar between men and women.[15] Although these data suggest the utility of TBS as an adjunctive test to BMD and FRAX to enhance the FRAX-probability of fracture, further validation is needed on whether TBS-adjusted FRAX can improve fracture prediction compared to unadjusted FRAX in the Korean population. In a community-based cohort of Korean women (1,165 women aged 45-76, MOF in 8.5% during 7.5 years of follow-up), each percent increment in unadjusted, BMD-adjusted, and TBS-adjusted FRAX probability for MOF was associated with the risk of MOF (HR, 1.08, 1.09, and 1.07, respectively).[16] However, TBS-adjusted FRAX did not improve fracture prediction than unadjusted FRAX in terms of Harrell’s C statistics. Further studies are suggested for research agendas, including the clinically applicable thresholds of TBS-adjusted FRAX probabilities in Koreans, additional assessment of the GR by TBS adjustment in larger, representative cohorts, and testing for calibration of TBS-adjusted FRAX probabilities.

3. The available evidence does not support routine monitoring of TBS in patients on antiresorptive agents

The least significant change (LSC) calculated using the precision of TBS is crucial for evaluating the value of repeated TBS testing for therapeutic monitoring. TBS LSC varied from 3.1% to 5.8% among facilities in previous studies, which was slightly worse than that of lumbar spine BMD.[9]
Table 3 summarizes the changes in TBS with antiresorptive agents. In patients who received oral antiresorptive treatment including alendronate, risedronate, and ibandronate, TBS increment was minimal (+0.2% [SD, 1.9] to +1.4% [SD, 6.6] per year) and well below the TBS LSC.[22,23] In line with these findings, a study of postmenopausal Korean women (N=191; mean age, 69.2 years) who were treated with oral alendronate, risedronate, or intravenous (IV) ibandronate reported an increased TBS of +0.33% (SD, 1.96) at 12 months.[24] Changes in TBS with antiresorptive therapy (bisphosphonate 80%) did not predict incident fractures in 9,044 women aged 40 years or older in the Manitoba DXA registry.[25] Three-year data from the HORIZON trial showed that mean changes in TBS at 36 months were +1.41% (SD, 0.79) in patients who received zoledronic acid 5 mg annually, without any significant gain in TBS in 65% of treated patients.[26] In a subgroup analysis of the FREEDOM trial comparing denosumab 60 mg (N=157) to placebo (N=128), the mean increase in TBS in the denosumab group was +2.4% at 36 months, and 80% of patients did not have increased TBS beyond the LSC.[27] Given that more than half the patients who received antiresorptive treatment - irrespective of potency and route - did not have an increase in TBS beyond the LSC despite an increase in BMD and fracture risk reduction, TBS would not be useful for monitoring patients on antiresorptive agents during the treatment period up to 3 years. It remains to be investigated if a more extended time interval might be necessary to detect significant TBS increase beyond LSC in patients on antiresorptive treatment.

4. TBS has the potential to improve anabolic response monitoring in addition to BMD measurements

The change in TBS with anabolic agents is shown in Table 3. In a study comparing teriparatide 20 mcg daily (N=65) with IV ibandronate 3 mg every 3 months (N=122) in postmenopausal women, the teriparatide group had a significantly larger gain in TBS compared to ibandronate (+4.3% vs. +0.3%) and larger lumbar spine BMD gain (+7.6% vs. +2.9%), at 24 months, showing TBS increase beyond LSC in 62% of patients in the teriparatide group.[28] Teriparatide treatment also increased TBS in patients with glucocorticoid-induced osteoporosis (+3.7%) at 36 months, whereas TBS remained unchanged in alendronate-treated patients at any time point compared to baseline.[29] Additionally, an abaloparatide (N=24) 80 μg-daily group yielded more robust gain in TBS than teriparatide (N=31) 20 mcg-daily group (+4.2% vs. +2.2%) at 24 weeks in a post-hoc analysis of phase 2 trials (postmenopausal women aged 55-85 years); however, abaloparatide is not yet available in Korea.[30] These data indicate that anabolic drugs, such as teriparatide or abaloparatide, may have more pronounced and favorable effects on bone microarchitecture within a relatively short period than bisphosphonates. Data on the effect of romosozumab on TBS changes are still lacking, which remains one of the research areas.


1. In postmenopausal women with type 2 diabetes mellitus, TBS is associated with major osteoporotic fracture risks

2. TBS can be useful in evaluating bone status in subjects with several medical conditions, but there is a lack of evidence on whether TBS predicts fracture risk in addition to BMD

Since TBS utilizes previously obtained images from DXA with a wealth of cross-sectional and longitudinal data, accuracy is one of its advantages. Studies have also demonstrated the advantages of evaluating and monitoring patients with certain conditions, such as type 2 diabetes mellitus (T2DM),[11,31-33] glucocorticoid-induced osteoporosis,[34,35] primary hyperparathyroidism (PHPT),[36-40] chronic kidney disease (CKD),[41-43] and subclinical and overt Cushing syndrome.[44,45] In addition, other conditions such as acromegaly,[46,47] rheumatoid arthritis,[48-50] osteoarthritis,[51,52] spondyloarthritis,[53-55] thyroid-stimulating hormone suppression,[56-58] and the use of aromatase inhibitors,[59,60] have been reported to be associated with decreased TBS (Table 4). However, conditions other than T2DM have been studied only in a small number of participants and fracture events, which is insufficient to recommend the use of TBS for assessing fracture risk.

3. Type 2 diabetes mellitus

In a retrospective study by Leslie et al. [11], women with T2DM had higher lumbar spine BMD but lower TBS than nondiabetic women at baseline. During the 4.7 years of follow-up, MOF events occurred more frequently in women with T2DM. Additionally, TBS was associated with higher fracture risk in women with and without T2DM (HR, 1.27; 95% CI, 1.10-1.46; and HR, 1.31; 95% CI, 1.24-1.38, respectively). In a study from the Korean Ansung cohort, Kim et al. [31] reported that TBS was significantly lower in men and women younger than 65 years with T2DM than in those without. In this study, TBS was inversely associated with HbA1c and the homeostatic model assessment for insulin resistance, indicating that the modality could be utilized to understand the paradoxically increased BMD in T2DM patients. In another study in patients with T2DM, patients with vertebral fractures had lower TBS than those without fractures, and TBS per 1 SD decrease had increased odds for fracture (OR, 1.80; 95% CI, 1.10-2.70).[32] In a recent meta-analysis, patients with T2DM had lower TBS than those without, with a mean difference of −0.31 (95% CI, −0.45 to −0.16),[33] fortifying the previous results. Therefore, TBS is a parameter that can be useful in explaining the excess risk of fracture in T2DM patients.

4. Glucocorticoid-induced osteoporosis

In a study by Paggiosi et al. [34], glucocorticoid-treated women had lower TBS than untreated women (Z-scores, −0.8 vs. 0) but had similar BMDs. TBS alone could discriminate between glucocorticoid-treated and untreated women (AUC, 0.721), while BMD alone could not (AUC, 0.572). In another study by Florez et al. [35] in patients treated with long-term glucocorticoids, TBS was better able to discriminate patients with fracture than BMD, especially vertebral fractures (AUC, 0.73), suggesting the future utility of TBS as a complementary tool in assessing the risk of fracture in patients with glucocorticoid-induced osteoporosis.

5. Primary hyperparathyroidism

PHPT has also been reported to be associated with TBS in previous studies. In a cross-sectional study by Romagnoli et al. [36], patients with PHPT had lower TBS than healthy postmenopausal women (1.19±0.10 vs. 1.24±0.09; P<0.01). Within PHPT patients, TBS could discriminate between those with and without vertebral fracture (AUC, 0.716; 95% CI, 0.590-0.841). In another cross-sectional study by Hong et al. [39], TBS was decreased in PHPT patients when compared to the controls (1.280±0.131 vs. 1.372±0.276; P=0.021), but lumbar spine BMD was similar (P=0.653). However, there was no difference in TBS in relation to vitamin D deficiency among patients with PHPT.[40] In a prospective observational study, baseline TBS was lower in patients with PHPT than in healthy controls (Z-score, −2.39± 1.79 vs. −0.98±1.07; P<0.01), and had an association with the odds of vertebral fracture (OR, 1.4; 95% CI, 1.1-1.9). Moreover, after parathyroidectomy, TBS increased by 47.0±44.8% over a year,[61] as reported in other studies.[37] Therefore, TBS may provide information towards the decision to recommend surgery, according to the Fourth International Workshop of Asymptomatic PHPT.[38]

6. CKD

CKD is a well-known risk factor for osteoporotic fractures.[41,42] The utility of BMD in assessing the risk of fractures has been inconsistent. Meanwhile, few studies on the effect of CKD on bone microarchitecture have been reported. Naylor et al. [43] reported that patients with CKD (eGFR <60 mL/min per 1.73 m2) and lower TBS (<1.277, the median) had a higher 5-year probability of fracture than those with higher TBS (HR, 1.62; 95% CI, 1.04-2.51). Consistent with other studies, lower TBS was independently associated with a higher risk of fracture while BMD was not,[62-64] implicating that CKD may affect the bone microarchitecture assessed by TBS.

7. Subclinical and overt Cushing syndrome

Cortisol excess is known to be associated with an increased risk of fracture, independent of BMD.[44] Several studies have investigated the association between cortisol excess and bone microarchitecture. Eller-Vainicher et al. [45] reported that patients with subclinical hypercortisolism had lower TBS than healthy controls (Z score, −3.18±1.21 vs. −1.19±0.99; P<0.01). Moreover, patients with low TBS were likely to experience fractures within 24 months (OR, 11.20; 95% CI, 1.71-71.41; P=0.012) after adjusting for age, body mass index (BMI), and baseline lumbar spine BMD. Moreover, Kim et al. [65]. recently reported that patients with subclinical hypercortisolism had a 2.2% lower TBS than those with nonfunctioning adrenal incidentalomas (P=0.040). A deteriorated bone microstructure (TBS <1.230) was also associated with the serum cortisol level after a 1 mg dexamethasone suppression test (OR, 2.18; 95% CI, 1.04-4.53).[65] In another study including both patients with overt and subclinical Cushing syndrome, TBS, but not BMD values, decreased with the degree of hypercortisolism (P<0.01). In addition, after remission of Cushing syndrome, TBS markedly improved when compared to BMD (10% vs. 3%; P<0.02).[66] Accordingly, TBS might be a potential parameter to explain fracture risks in patients with cortisol excess, with further prospective studies.


1. High BMI and soft tissue thickness can attenuate the negative correlation of TBS, but this can be overcome by using an upgraded version of the TBS algorithm

In a study by Shin et al. [67] on 1,505 Korean women aged ≥40 years, 160 subjects with high BMI were found to have a more degraded TBS than BMD. Leslie et al. [68] reported that among 29,407 women ≥50 years, obese subjects with BMI over 30 kg/m2 had a negative correlation with TBS. According to the manufacturer, BMI between 15 and 37 kg/m2 is reliable for TBS analysis.
Kim et al. [69] reported that relatively visceral fat might have a more detrimental effect on TBS than subcutaneous fat. Moreover, Amnuaywattakorn et al. [70] demonstrated that increased soft-tissue thickness resulted in lower TBS values. The DXA image became fuzzier as soft tissue thickness increases, as the soft tissue act like a blurring filter. Therefore, variations among the image pixels decreases which leads to lowered TBS value.[70] Although BMD is affected by soft tissue thickness, it does not cause a clinical problem because these changes do not exceed LSC. An updated version of the TBS version 4.0 algorithm tested by Shevroja et al. [7] was found to overcome this residual negative correlation of the current TBS with body size and composition parameters and is suggested to be free from previously acknowledged technical limitations.
There were sex and ethnic differences in TBS. The older software versions were optimized only for women, and the TBS value using the old version was higher in women than in men. Therefore, TBS version 2.1 and above should be used in men.[71] TBS was higher in non-Hispanic white women and lower in non-Hispanic black and Mexican-American women.[5] The TBS reference range has also been applied only to postmenopausal women. In addition, since there is a lack of a well-established cut-off point for TBS, a large population study would be required to determine the optimal ranges across age and sex.[8]

2. There are several technical issues that affect the results of TBS

Gray-level variations related to vertebral shape and size, heterogeneity among the detectors in the DXA machine, and image noise can be superimposed on those gray-level variations related to the microarchitecture. The CaMos study [72], a Canada-wide population-based prospective cohort study, demonstrated that lumbar spine TBS and BMI showed a significant negative correlation using only Hologic, but not GE-Lunar densitometers. For clinical and research applications, TBS using DXA densitometers from different manufacturers should be gathered for analysis.
TBS values were reduced by image noise, regardless of the pixel size considered, and contributed to the degradation of resolution. Winzenrieth et al. [73] demonstrated that the average value of TBS decreased when noise was added. However, it did not significantly affect the correlation between TBS and 3D parameters. Accordingly, DXA scanners should be preserved within normal conditions, and causes of inappropriate noise such as aging X-ray tubes and sensor deficiencies should be managed.
In terms of DXA scan modes, the reproducibility of TBS was lower than that of BMD, but differences between the 3 DXA scan modes, such as fast-array, array, and high-definition, were not significant in terms of TBS.[74] The difference in reproducibility among the 3 scan modes was not significant for either BMD or TBS (P=0.942). We have summarized the limitations of TBS in Table 4.


TBS has an additional role apart from BMD in assessing osteoporotic fracture risk and clinical risk factors in postmenopausal women and men over 50 years old and has been supported by several studies. Thus, TBS may be applied to assess fracture risk and to adjust the FRAX probability of fracture, which determines treatment initiation. TBS alone was not sufficient to initiate treatment or monitor the effect of antiresorptive agents. However, TBS can be helpful in monitoring the response to anabolic agents. The recently upgraded version TBS version 4.0 can overcome the technical limitations of soft tissue interference. By understanding the advantages and limitations of TBS, we can optimize the use of TBS in clinical practice.


Ethics approval and consent to participate

Not applicable.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Fig. 1
An example of trabecular bone score results.
Table 1
Cross-sectional and longitudinal studies of trabecular bone score and fracture risk in women
References Year Population Mean age (yr) Fractured population (N) Compared population (N) Outcome Unadjusted OR/HR (95% CI) Adjusted OR/HR (95% CI) Covariates
Pothuaud et al. [75] 2009 Caucasian, postmenopause 66.9 45 90 age and LS BMD matched controls Vertebral, hip, and other types of osteoporotic fracture OR 1.95 (1.31-2.89) (−) (−)

Winzenrieth et al. [76] 2010 Caucasian, postmenopause 63.1 81 162 age-matched controls Vertebral fracture OR 2.53 (1.82-3.53) OR 1.97 (1.31-2.96) Weight

Rabier et al. [77] 2010 Caucasian, postmenopause 64.0 42 126 age-matched controls Vertebral fracture OR 3.20 (2.01-5.08) OR 3.81 (2.17-6.72) Weight

Del Rio et al. [78] 2013 Caucasian, postmenopause 66.9 83 108 Hip fracture OR 2.05 (1.45-2.89) OR 1.66 (1.15-2.40) Age, BMI, body weight

Krueger et al. [10] 2014 Caucasian, postmenopause 71.6 158 271 age-matched control Fragility fracture (−) OR 2.36 (1.8-3.0) Age, BMI, lowest T-score

Vasic et al. [79] 2014 Caucasian 62.9 271 760 Fragility fracture OR 1.79 (1.54-2.08) OR 1.27 (1.07-1.51) Age and LS BMD

Leib et al. [80] 2014 Caucasian, >40 yr 57.7 289 1,876 Fragility fracture OR 1.38 (1.22-1.56) OR 1.28 (1.13-1.46) Age and family history of fracture

Hans et al. [13] 2011 Caucasian, >50 yr (4.6 yr of FU) 65.4 1,668 27,739 Clinical vertebral fracture HR 1.45 (1.32-1.58) HR 1.14 (1.03-1.26) Comorbidity score, COPD, diabetes, substance abuse, BMI, prior osteoporotic fracture, steroid use, osteoporosis treatment
Hip fracture HR 1.46 (1.30-1.63) HR 1.47 (1.30-1.67)
MOF HR 1.35 (1.29-1.42) HR 1.17 (1.09-1.25)

Leslie et al. [12] 2014 Caucasian, >40 yr (4.7 yr of FU) 63.0 1,872 31,480 MOF HR 1.36 (1.30-1.42) HR 1.18 (1.12-1.23) FN BMD, BMI, previous fracture, COPD, steroid use, rheumatoid arthritis, secondary osteoporosis, alcohol use

Iki et al. [14] 2014 Asian, postmenopausal (8.3 yr of FU) 64.1 92 574 Vertebral fracture HR 1.20 (1.19-1.21) HR 1.19 (1.18-1.20) Age, height, weight, vertebral deformity, LS BMD, osteoporosis treatment

McCloskey et al. [15] 2016 Asian, Caucasian (6.1 yr of FU) 72.0 1,109 9,398 MOF (−) HR 1.31 (1.21-1.42) Age, FRAX, time since baseline
298 10,209 Hip fracture (−) HR 1.29 (1.09-1.52) Age, FRAX, time since baseline

Su et al. [18] 2017 Asian, ≥65 yr (8.8 yr of FU) 72.6 215 1,739 MOF HR 1.60 (1.17-2.20)a) (−) (−)

Tamaki et al. [20] 2019 Asian, >40 yr (10 yr of FU) 58.1 67 1,474 MOF (−) OR 1.46 (1.08-1.98) FRAX, FN BMD

Kim et al. [16] 2020 Asian, >45 yr (7.5 yr of FU) 61.6 99 1,066 MOF HR 1.43 (1.11-1.82) HR 1.16 (0.83-1.62) Age, BMI, menopause, previous fracture history, LS BMD, FN BMD

a) HR compared to highest tertile of trabecular bone score (TBS). Tertiles of TBS by sex from the MR/MS OS study in Hong Kong; 1st: ≥1.291, 2nd: 1.227-1.290, 3rd: ≤1.226.

FU, follow-up; LS, lumbar spine; BMD, bone mineral density; MOF, major osteoporotic fractures; OR, odds ratio; HR, hazard ratio; CI, confidence interval; BMI, body mass index; COPD, chronic obstructive pulmonary disease; FN, femur neck; FRAX, Fracture Risk Assessment Tool.

Table 2
Cross-sectional and longitudinal studies of trabecular bone score and fracture risk in men
References Year Population Mean age (yr) Fractured population (N) Compared population (N) Outcome Unadjusted OR/HR (95% CI) Adjusted OR/HR (95% CI) Covariates
Leib et al. [80] 2014 Caucasian, >40 yr 63.0 45 135 age and LS BMD matched controls Fragility fracture OR 1.55 (1.09-2.20) (−) (−)

Iki et al. [17] 2015 Asian, ≥65 yr 73.0 23 1,850 MOF OR 1.89 (1.28-2.81) OR 1.76 (1.16-2.67) FRAX

Schousboe et al. [19] 2016 Caucasian, ≥65 yr (10 yr of FU) 73.7 448 5,415 MOF (−) HR 1.27 (1.17-1.39) FRAX, LS BMD, radiographic vertebral fracture
181 5,682 Hip fracture (−) HR 1.20 (1.05-1.39)

McCloskey et al. [15] 2016 Asian, Caucasian (6.1 yr of FU) 72.0 1,109 6,193 MOF (−) HR 1.35 (1.21-1.49) Age, FRAX, time since baseline
298 7,004 Hip fracture (−) HR 1.27 (1.06-1.53) Age, FRAX, time since baseline

Su et al. [18] 2017 Asian, ≥65 yr (9.9 yr of FU) 72.4 126 1,783 MOF HR 3.04 (1.92-4.81)a) (−) (−)

a) HR compared to highest tertile of trabecular bone score (TBS). Tertiles of TBS by sex from the MR/MS OS study in Hong Kong; 1st: ≥1.317, 2nd: 1.249-1.316, 3rd: ≤1.248.

FU, follow-up; LS, lumbar spine; BMD, bone mineral density; MOF, major osteoporotic fractures; OR, odds ratio; HR, hazard ratio; CI, confidence interval; FRAX, Fracture Risk Assessment Tool.

Table 3
Change in trabecular bone score with antiresorptive or anabolic agents
References Year Study population Age (mean±SD) Treatment groups (N) FU (yr) Percent change in lumbar spine TBS (mean±SD) Reported LSC of TBS
Krieg et al. [22] 2013 1,634 women aged 50 or older (Manitoba cohort) 63±8 Antiresorptive agents (N=534)a) 3.7 +0.2±1.9%/yr 5.8%
Untreated subjects (N=1,150) −0.3±0.1%/yr

Popp et al. [26] 2013 107 postmenopausal women (HORIZON trial subset) 77±5 Zoledronic acid (N=54) 3 +1.4±0.8% 3.1%
Placebo (N=53) −0.5±0.6%

Senn et al. [28] 2014 187 postmenopausal women with osteoporosis 68±8 Teriparatide (N=65) 2 +4.3±6.6% 3.1%
Ibandronate (N=122)

Di Gregorio et al. [23] 2015 390 individuals aged 40 or older (318 women, 72 men) 66±9 Untreated (N=67) 1.7 −3.1±6.4% Not reported
Alendronate (N=88) +1.4±5.5%
Risedronate (N=39) +1.4±6.6%
Denosumab (N=43) +2.8±5.7%
Teriparatide (N=30) +3.6±6.0%

Saag et al. [29] 2016 109 patients with glucocorticoid therapy-induced osteoporosis (89 women, 20 men) 58±13 Alendronate (N=53) 3 No significant change 3.9%
Teriparatide (N=56) +3.7%

McClung et al. [27] 2017 285 postmenopausal women with osteoporosis (FREEDOM trial subset) 73±5 Denosumab (N=157) 3 +2.4% 5.82%
Placebo (N=128) +0.7%

Shin et al. [24] 2017 191 postmenopausal Korean women 69±9 Oral bisphosphonate (alendronate, N=131; risedronate, N=19; ibandronate, N=59) 1 (N=191) +0.3±0.4% Not reported
2 (N=117) +1.4±0.6%
3 (N=66) +1.9±0.7%
4 (N=34) +2.7±1.0%

Bilezikian et al. [30] 2018 138 postmenopausal women 66±7 Abaloparatide 80 mcg (N=24) 0.5 +5.2% 4.2%
Abaloparatide 40 mcg (N=25) +4.2%
Abaloparatide 20 mcg (N=29) +3.3%
Teriparatide 20 mcg (N=31) +2.2%
Placebo (N=29) −1.1%

a) The most common were bisphosphonates (86% overall, majority was alendronate [73%]), followed by raloxifene (10%) and calcitonin (4%).

HORIZON, Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly; FREEDOM, Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months; SD, standard deviation; FU, follow-up; TBS, trabecular bone score; LSC, least significant change.

Table 4
Useful medical conditions and limitations of trabecular bone score
Advantages Limitations
Usefulness to evaluate and monitor patients with T2DMa), GIOP, PHPT, CKD, subclinical and overt Cushing syndrome - Negative correlation with high BMI, soft tissue thickness, image noise
- Heterogeneity among the DXA: machines (GE-lunar or Hologic)
- Lower reproducibility than BMD

a) In postmenopausal women with T2DM, trabecular bone score is associated with major osteoporotic fracture risk.

T2DM, type 2 diabetes mellitus; GIOP, glucocorticoid-induced osteoporosis; PHPT, primary hyperparathyroidism; CKD, chronic kidney disease; BMI, body mass index; DXA, dual energy X-ray absorptiometry; BMD, bone mineral density.


1. Siris ES, Chen YT, Abbott TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 2004;164:1108-12. https://doi.org/10.1001/archinte.164.10.1108.
crossref pmid
2. Dalle Carbonare L, Giannini S. Bone microarchitecture as an important determinant of bone strength. J Endocrinol Invest 2004;27:99-105. https://doi.org/10.1007/bf03350919.
crossref pmid
3. Silva BC, Broy SB, Boutroy S, et al. Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 2: Trabecular bone score. J Clin Densitom 2015;18:309-30. https://doi.org/10.1016/j.jocd.2015.06.008.
crossref pmid
4. Pothuaud L, Carceller P, Hans D. Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture. Bone 2008;42:775-87. https://doi.org/10.1016/j.bone.2007.11.018.
5. Martineau P, Leslie WD. The utility and limitations of using trabecular bone score with FRAX. Curr Opin Rheumatol 2018;30:412-9. https://doi.org/10.1097/bor.0000000000000504.
6. Hans D, Barthe N, Boutroy S, et al. Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom 2011;14:302-12. https://doi.org/10.1016/j.jocd.2011.05.005.
crossref pmid
7. Shevroja E, Aubry-Rozier B, Hans G, et al. Clinical performance of the updated trabecular bone score (TBS) algorithm, which accounts for the soft tissue thickness: The osteoLaus study. J Bone Miner Res 2019;34:2229-37. https://doi.org/10.1002/jbmr.3851.
crossref pmid
8. Silva BC, Leslie WD, Resch H, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res 2014;29:518-30. https://doi.org/10.1002/jbmr.2176.
crossref pmid
9. Krohn K, Schwartz EN, Chung YS, et al. Dual-energy X-ray absorptiometry monitoring with trabecular bone score: 2019 ISCD official position. J Clin Densitom 2019;22:501-5. https://doi.org/10.1016/j.jocd.2019.07.006.
crossref pmid
10. Krueger D, Fidler E, Libber J, et al. Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women. J Clin Densitom 2014;17:60-5. https://doi.org/10.1016/j.jocd.2013.05.001.
crossref pmid
11. Leslie WD, Aubry-Rozier B, Lamy O, et al. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab 2013;98:602-9. https://doi.org/10.1210/jc.2012-3118.
crossref pmid
12. Leslie WD, Johansson H, Kanis JA, et al. Lumbar spine texture enhances 10-year fracture probability assessment. Osteoporos Int 2014;25:2271-7. https://doi.org/10.1007/s00198-014-2761-y.
crossref pmid
13. Hans D, Goertzen AL, Krieg MA, et al. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res 2011;26:2762-9. https://doi.org/10.1002/jbmr.499.
crossref pmid
14. Iki M, Tamaki J, Kadowaki E, et al. Trabecular bone score (TBS) predicts vertebral fractures in Japanese women over 10 years independently of bone density and prevalent vertebral deformity: the Japanese Population-Based Osteoporosis (JPOS) cohort study. J Bone Miner Res 2014;29:399-407. https://doi.org/10.1002/jbmr.2048.
crossref pmid
15. McCloskey EV, Odén A, Harvey NC, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res 2016;31:940-8. https://doi.org/10.1002/jbmr.2734.
crossref pmid
16. Kim H, Kim JH, Kim MJ, et al. Low predictive value of FRAX adjusted by trabecular bone score for osteoporotic fractures in Korean women: A community-based cohort study. Endocrinol Metab (Seoul) 2020;35:359-66. https://doi.org/10.3803/EnM.2020.35.2.359.
crossref pmid pmc
17. Iki M, Fujita Y, Tamaki J, et al. Trabecular bone score may improve FRAX® prediction accuracy for major osteoporotic fractures in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Osteoporos Int 2015;26:1841-8. https://doi.org/10.1007/s00198-015-3092-3.
crossref pmid
18. Su Y, Leung J, Hans D, et al. Added clinical use of trabecular bone score to BMD for major osteoporotic fracture prediction in older Chinese people: the Mr. OS and Ms. OS cohort study in Hong Kong. Osteoporos Int 2017;28:151-60. https://doi.org/10.1007/s00198-016-3785-2.
crossref pmid
19. Schousboe JT, Vo T, Taylor BC, et al. Prediction of incident major osteoporotic and hip fractures by trabecular bone score (TBS) and prevalent radiographic vertebral fracture in older men. J Bone Miner Res 2016;31:690-7. https://doi.org/10.1002/jbmr.2713.
crossref pmid
20. Tamaki J, Iki M, Sato Y, et al. Does Trabecular Bone Score (TBS) improve the predictive ability of FRAX(®) for major osteoporotic fractures according to the Japanese Population-Based Osteoporosis (JPOS) cohort study? J Bone Miner Metab 2019;37:161-70. https://doi.org/10.1007/s00774-018-0910-7.
crossref pmid
21. McCloskey EV, Odén A, Harvey NC, et al. Adjusting fracture probability by trabecular bone score. Calcif Tissue Int 2015;96:500-9. https://doi.org/10.1007/s00223-015-9980-x.
crossref pmid
22. Krieg MA, Aubry-Rozier B, Hans D, et al. Effects of anti-resorptive agents on trabecular bone score (TBS) in older women. Osteoporos Int 2013;24:1073-8. https://doi.org/10.1007/s00198-012-2155-y.
crossref pmid
23. Di Gregorio S, Del Rio L, Rodriguez-Tolra J, et al. Comparison between different bone treatments on areal bone mineral density (aBMD) and bone microarchitectural texture as assessed by the trabecular bone score (TBS). Bone 2015;75:138-43. https://doi.org/10.1016/j.bone.2014.12.062.
crossref pmid
24. Shin MS, Cho EH, Kim HY. Longitudinal change in trabecular bone score during and after treatment of osteoporosis in postmenopausal Korean women. J Bone Metab 2017;24:117-24. https://doi.org/10.11005/jbm.2017.24.2.117.
crossref pmid pmc
25. Leslie WD, Majumdar SR, Morin SN, et al. Change in trabecular bone score (TBS) with antiresorptive therapy does not predict fracture in women: The manitoba BMD cohort. J Bone Miner Res 2017;32:618-23. https://doi.org/10.1002/jbmr.3054.
crossref pmid
26. Popp AW, Guler S, Lamy O, et al. Effects of zoledronate versus placebo on spine bone mineral density and microarchitecture assessed by the trabecular bone score in postmenopausal women with osteoporosis: a three-year study. J Bone Miner Res 2013;28:449-54. https://doi.org/10.1002/jbmr.1775.
crossref pmid
27. McClung MR, Lippuner K, Brandi ML, et al. Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis. Osteoporos Int 2017;28:2967-73. https://doi.org/10.1007/s00198-017-4140-y.
crossref pmid
28. Senn C, Günther B, Popp AW, et al. Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study. Osteoporos Int 2014;25:1945-51. https://doi.org/10.1007/s00198-014-2703-8.
crossref pmid
29. Saag KG, Agnusdei D, Hans D, et al. Trabecular bone score in patients with chronic glucocorticoid therapy-induced osteoporosis treated with alendronate or teriparatide. Arthritis Rheumatol 2016;68:2122-8. https://doi.org/10.1002/art.39726.
crossref pmid
30. Bilezikian JP, Hattersley G, Fitzpatrick LA, et al. Abaloparatide-SC improves trabecular microarchitecture as assessed by trabecular bone score (TBS): a 24-week randomized clinical trial. Osteoporos Int 2018;29:323-8. https://doi.org/10.1007/s00198-017-4304-9.
crossref pmid
31. Kim JH, Choi HJ, Ku EJ, et al. Trabecular bone score as an indicator for skeletal deterioration in diabetes. J Clin Endocrinol Metab 2015;100:475-82. https://doi.org/10.1210/jc.2014-2047.
crossref pmid
32. Choi YJ, Ock SY, Chung YS. Trabecular bone score (TBS) and TBS-adjusted fracture risk assessment tool are potential supplementary tools for the discrimination of morphometric vertebral fractures in postmenopausal women with type 2 diabetes. J Clin Densitom 2016;19:507-14. https://doi.org/10.1016/j.jocd.2016.04.001.
crossref pmid
33. Ho-Pham LT, Nguyen TV. Association between trabecular bone score and type 2 diabetes: a quantitative update of evidence. Osteoporos Int 2019;30:2079-85. https://doi.org/10.1007/s00198-019-05053-z.
crossref pmid
34. Paggiosi MA, Peel NF, Eastell R. The impact of glucocorticoid therapy on trabecular bone score in older women. Osteoporos Int 2015;26:1773-80. https://doi.org/10.1007/s00198-015-3078-1.
crossref pmid
35. Florez H, Hernández-Rodríguez J, Muxi A, et al. Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis. Rheumatology (Oxford) 2020;59:1574-80. https://doi.org/10.1093/rheumatology/kez464.
crossref pmid
36. Romagnoli E, Cipriani C, Nofroni I, et al. “Trabecular Bone Score” (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism. Bone 2013;53:154-9. https://doi.org/10.1016/j.bone.2012.11.041.
crossref pmid
37. Rolighed L, Rejnmark L, Sikjaer T, et al. Vitamin D treatment in primary hyperparathyroidism: a randomized placebo controlled trial. J Clin Endocrinol Metab 2014;99:1072-80. https://doi.org/10.1210/jc.2013-3978.
crossref pmid
38. Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014;99:3561-9. https://doi.org/10.1210/jc.2014-1413.
crossref pmid pmc
39. Hong AR, Lee JH, Kim JH, et al. Effect of endogenous parathyroid hormone on bone geometry and skeletal microarchitecture. Calcif Tissue Int 2019;104:382-9. https://doi.org/10.1007/s00223-019-00517-0.
crossref pmid
40. Lee JH, Kim JH, Hong AR, et al. Skeletal effects of vitamin D deficiency among patients with primary hyperparathyroidism. Osteoporos Int 2017;28:1667-74. https://doi.org/10.1007/s00198-017-3918-2.
crossref pmid
41. Stehman-Breen CO, Sherrard DJ, Alem AM, et al. Risk factors for hip fracture among patients with end-stage renal disease. Kidney Int 2000;58:2200-5. https://doi.org/10.1111/j.1523-1755.2000.00394.x.
crossref pmid
42. Alem AM, Sherrard DJ, Gillen DL, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 2000;58:396-9. https://doi.org/10.1046/j.1523-1755.2000.00178.x.
crossref pmid
43. Naylor KL, Prior J, Garg AX, et al. Trabecular bone score and incident fragility fracture risk in adults with reduced kidney function. Clin J Am Soc Nephrol 2016;11:2032-40. https://doi.org/10.2215/cjn.00720116.
crossref pmid pmc
44. Vestergaard P, Lindholm J, Jørgensen JO, et al. Increased risk of osteoporotic fractures in patients with Cushing’s syndrome. Eur J Endocrinol 2002;146:51-6. https://doi.org/10.1530/eje.0.1460051.
crossref pmid
45. Eller-Vainicher C, Morelli V, Ulivieri FM, et al. Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism. J Bone Miner Res 2012;27:2223-30. https://doi.org/10.1002/jbmr.1648.
crossref pmid
46. Hong AR, Kim JH, Kim SW, et al. Trabecular bone score as a skeletal fragility index in acromegaly patients. Osteoporos Int 2016;27:1123-9. https://doi.org/10.1007/s00198-015-3344-2.
crossref pmid
47. Godang K, Olarescu NC, Bollerslev J, et al. Treatment of acromegaly increases BMD but reduces trabecular bone score: a longitudinal study. Eur J Endocrinol 2016;175:155-64. https://doi.org/10.1530/eje-16-0340.
48. Bréban S, Briot K, Kolta S, et al. Identification of rheumatoid arthritis patients with vertebral fractures using bone mineral density and trabecular bone score. J Clin Densitom 2012;15:260-6. https://doi.org/10.1016/j.jocd.2012.01.007.
crossref pmid
49. Kim D, Cho SK, Kim JY, et al. Association between trabecular bone score and risk factors for fractures in Korean female patients with rheumatoid arthritis. Mod Rheumatol 2016;26:540-5. https://doi.org/10.3109/14397595.2015.1101212.
crossref pmid
50. Choi YJ, Chung YS, Suh CH, et al. Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore) 2017;96:e8661.https://doi.org/10.1097/md.0000000000008661.
crossref pmid pmc
51. Kolta S, Briot K, Fechtenbaum J, et al. TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int 2014;25:1759-64. https://doi.org/10.1007/s00198-014-2685-6.
crossref pmid
52. Anderson KB, Holloway-Kew KL, Mohebbi M, et al. Is trabecular bone score less affected by degenerative-changes at the spine than lumbar spine BMD? Arch Osteoporos 2018;13:127.https://doi.org/10.1007/s11657-018-0544-3.
crossref pmid
53. Wildberger L, Boyadzhieva V, Hans D, et al. Impact of lumbar syndesmophyte on bone health as assessed by bone density (BMD) and bone texture (TBS) in men with axial spondyloarthritis. Joint Bone Spine 2017;84:463-6. https://doi.org/10.1016/j.jbspin.2016.05.015.
crossref pmid
54. Boussoualim K, Amouzougan A, Pallot-Prades B, et al. Evaluation of bone quality with trabecular bone score in active spondyloarthritis. Joint Bone Spine 2018;85:727-31. https://doi.org/10.1016/j.jbspin.2018.02.006.
crossref pmid
55. Kang KY, Goo HY, Park SH, et al. Trabecular bone score as an assessment tool to identify the risk of osteoporosis in axial spondyloarthritis: a case-control study. Rheumatology (Oxford) 2018;57:462-9. https://doi.org/10.1093/rheumatology/kex377.
crossref pmid
56. Moon JH, Kim KM, Oh TJ, et al. The effect of TSH suppression on vertebral trabecular bone scores in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 2017;102:78-85. https://doi.org/10.1210/jc.2016-2740.
crossref pmid
57. De Mingo Dominguez ML, Guadalix Iglesias S, Martin-Arriscado Arroba C, et al. Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy. Endocrine 2018;62:166-73. https://doi.org/10.1007/s12020-018-1671-8.
crossref pmid
58. Hawkins Carranza F, Guadalix Iglesias S, Luisa De Mingo Domínguez M, et al. Trabecular bone deterioration in differentiated thyroid cancer: Impact of long-term TSH suppressive therapy. Cancer Med 2020;9:5746-55. https://doi.org/10.1002/cam4.3200.
crossref pmid pmc
59. Hong AR, Kim JH, Lee KH, et al. Long-term effect of aromatase inhibitors on bone microarchitecture and macroarchitecture in non-osteoporotic postmenopausal women with breast cancer. Osteoporos Int 2017;28:1413-22. https://doi.org/10.1007/s00198-016-3899-6.
crossref pmid
60. Mariotti V, Page DB, Davydov O, et al. Assessing fracture risk in early stage breast cancer patients treated with aromatase-inhibitors: An enhanced screening approach incorporating trabecular bone score. J Bone Oncol 2017;7:32-7. https://doi.org/10.1016/j.jbo.2016.10.004.
crossref pmid
61. Eller-Vainicher C, Filopanti M, Palmieri S, et al. Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism. Eur J Endocrinol 2013;169:155-62. https://doi.org/10.1530/eje-13-0305.
crossref pmid
62. Naylor KL, Lix LM, Hans D, et al. Trabecular bone score in kidney transplant recipients. Osteoporos Int 2016;27:1115-21. https://doi.org/10.1007/s00198-015-3424-3.
crossref pmid
63. Luckman M, Hans D, Cortez N, et al. Spine trabecular bone score as an indicator of bone microarchitecture at the peripheral skeleton in kidney transplant recipients. Clin J Am Soc Nephrol 2017;12:644-52. https://doi.org/10.2215/cjn.09850916.
crossref pmid pmc
64. Pérez-Sáez MJ, Herrera S, Prieto-Alhambra D, et al. Bone density, microarchitecture, and tissue quality long-term after kidney transplant. Transplantation 2017;101:1290-4. https://doi.org/10.1097/tp.0000000000001328.
crossref pmid
65. Kim BJ, Kwak MK, Ahn SH, et al. The association of cortisol and adrenal androgen with trabecular bone score in patients with adrenal incidentaloma with and without autonomous cortisol secretion. Osteoporos Int 2018;29:2299-307. https://doi.org/10.1007/s00198-018-4608-4.
crossref pmid
66. Vinolas H, Grouthier V, Mehsen-Cetre N, et al. Assessment of vertebral microarchitecture in overt and mild Cushing’s syndrome using trabecular bone score. Clin Endocrinol (Oxf) 2018;89:148-54. https://doi.org/10.1111/cen.13743.
crossref pmid
67. Shin YH, Gong HS, Lee KJ, et al. Older age and higher body mass index are associated with a more degraded trabecular bone score compared to bone mineral density. J Clin Densitom 2019;22:266-71. https://doi.org/10.1016/j.jocd.2017.06.006.
crossref pmid
68. Leslie WD, Krieg MA, Hans D. Clinical factors associated with trabecular bone score. J Clin Densitom 2013;16:374-9. https://doi.org/10.1016/j.jocd.2013.01.006.
crossref pmid
69. Kim JH, Choi HJ, Ku EJ, et al. Regional body fat depots differently affect bone microarchitecture in postmenopausal Korean women. Osteoporos Int 2016;27:1161-8. https://doi.org/10.1007/s00198-015-3329-1.
crossref pmid
70. Amnuaywattakorn S, Sritara C, Utamakul C, et al. Simulated increased soft tissue thickness artefactually decreases trabecular bone score: a phantom study. BMC Musculoskelet Disord 2016;17:17.https://doi.org/10.1186/s12891-016-0886-1.
crossref pmid pmc
71. Schacter GI, Leslie WD, Majumdar SR, et al. Clinical performance of an updated trabecular bone score (TBS) algorithm in men and women: the Manitoba BMD cohort. Osteoporos Int 2017;28:3199-203. https://doi.org/10.1007/s00198-017-4166-1.
crossref pmid
72. Mazzetti G, Berger C, Leslie WD, et al. Densitometer-specific differences in the correlation between body mass index and lumbar spine trabecular bone score. J Clin Densitom 2017;20:233-8. https://doi.org/10.1016/j.jocd.2016.11.003.
crossref pmid
73. Winzenrieth R, Michelet F, Hans D. Three-dimensional (3D) microarchitecture correlations with 2D projection image gray-level variations assessed by trabecular bone score using high-resolution computed tomographic acquisitions: effects of resolution and noise. J Clin Densitom 2013;16:287-96. https://doi.org/10.1016/j.jocd.2012.05.001.
crossref pmid
74. Bandirali M, Poloni A, Sconfienza LM, et al. Short-term precision assessment of trabecular bone score and bone mineral density using dual-energy X-ray absorptiometry with different scan modes: an in vivo study. Eur Radiol 2015;25:2194-8. https://doi.org/10.1007/s00330-015-3606-6.
crossref pmid
75. Pothuaud L, Barthe N, Krieg MA, et al. Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: a preliminary spine BMD-matched, case-control study. J Clin Densitom 2009;12:170-6. https://doi.org/10.1016/j.jocd.2008.11.006.
crossref pmid
76. Winzenrieth R, Dufour R, Pothuaud L, et al. A retrospective case-control study assessing the role of trabecular bone score in postmenopausal Caucasian women with osteopenia: analyzing the odds of vertebral fracture. Calcif Tissue Int 2010;86:104-9. https://doi.org/10.1007/s00223-009-9322-y.
crossref pmid
77. Rabier B, Héraud A, Grand-Lenoir C, et al. A multicentre, retrospective case-control study assessing the role of trabecular bone score (TBS) in menopausal Caucasian women with low areal bone mineral density (BMDa): Analysing the odds of vertebral fracture. Bone 2010;46:176-81. https://doi.org/10.1016/j.bone.2009.06.032.
crossref pmid
78. Del Rio LM, Winzenrieth R, Cormier C, et al. Is bone microarchitecture status of the lumbar spine assessed by TBS related to femoral neck fracture? A Spanish case-control study. Osteoporos Int 2013;24:991-8. https://doi.org/10.1007/s00198-012-2008-8.
crossref pmid
79. Vasic J, Petranova T, Povoroznyuk V, et al. Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: the Eastern European TBS study. J Bone Miner Metab 2014;32:556-62. https://doi.org/10.1007/s00774-013-0529-7.
crossref pmid
80. Leib E, Winzenrieth R, Lamy O, et al. Comparing bone microarchitecture by trabecular bone score (TBS) in Caucasian American women with and without osteoporotic fractures. Calcif Tissue Int 2014;95:201-8. https://doi.org/10.1007/s00223-014-9882-3.
crossref pmid
METRICS Graph View
  • 24 Crossref
  • 5 Scopus 
  • 31,180 View
  • 501 Download

Sung Hye Kong

Namki Hong

Jung Hee Kim

Related articles


Browse all articles >

Editorial Office
#1001, Hyundai Kirim Officetel, 42 Seocho-daero 78-gil, Seocho-gu, Seoul 06626, Korea
Tel: +82-2-3473-2231    Fax: +82-70-4156-2230    E-mail: editors.jbm@gmail.com                

Copyright © 2024 by The Korean Society for Bone and Mineral Research.

Developed in M2PI

Close layer
prev next