title: Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice.
abstract: Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. Electronic address: nch@mrc.soton.ac.uk.
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.affiliation: Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: C C
authors.initials: CC
authors.lastname: Glüer
authors.affiliation: Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: N
authors.initials: N
authors.lastname: Binkley
authors.affiliation: Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
authors.forename: E V
authors.initials: EV
authors.lastname: McCloskey
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: M-L
authors.initials: ML
authors.lastname: Brandi
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Kendler
authors.affiliation: Bone Unit, University Hospital, Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Lamy
authors.affiliation: Scientific Office, Austrian Agency for Health and Food Safety, Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Laslop
authors.affiliation: Unidade de Densitometria Óssea, Densimater Rede Materdei de Saúde, Belo Horizonte, MG, Brazil.
authors.forename: B M
authors.initials: BM
authors.lastname: Camargos
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Reginster
authors.affiliation: Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
authors.affiliation: Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. Electronic address: w.j.pontefract@sheffield.ac.uk.
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000465:Algorithms; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005269:Femur / Q000473:pathology; D017102:Fracture Healing; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000503:physiopathology; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors
keywords: Bone mineral density; Epidemiology; FRAX; Fragility fracture; Osteoporosis; Trabecular bone score (TBS)