Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical & Translational Metabolism
Published in: Clinical Reviews in Bone and Mineral Metabolism 1/2016

01-03-2016 | Assessment of bone health

Clinical Application of Spine Trabecular Bone Score (TBS)

Authors: Neil Binkley, William D. Leslie

Published in: Clinical & Translational Metabolism | Issue 1/2016

Login to get access

Abstract

Trabecular bone score (TBS) is a software program recently approved by the US Food and Drug Administration for post-acquisition processing of lumbar spine dual-energy X-ray absorptiometry images that allows assessment of bone texture as a surrogate for bone microarchitecture. Low TBS values are associated with increased risk of major osteoporotic fracture risk in postmenopausal women and men aged 40 years and older independent of BMD. TBS data can be used to adjust FRAX probability of fracture. As such, TBS data can be useful in osteoporosis treatment initiation decisions. Following treatment initiation, TBS increases are smaller than seen with BMD; at present, there is insufficient evidence that TBS can be used to monitor treatment. TBS may be particularly helpful in fracture risk prediction for those with diabetes mellitus or receiving glucocorticoid therapy, but additional validation of existing observations is needed. In summary, TBS should not be used alone to guide treatment initiation, but can be used with FRAX to estimate fracture probability in postmenopausal women and older men, thereby facilitating treatment initiation decisions.
Literature
1.
Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud KE, Browner W, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. 2003;18:1947–54.CrossRefPubMed
2.
Kanis JA, Melton LJI, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137–41.CrossRefPubMed
3.
Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP. Updated data on proximal femur bone mineral levels of U.S. adults. Osteoporos Int. 1998;8:468–89.CrossRefPubMed
4.
Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJI, Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42:467–75.CrossRefPubMed
5.
Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20(7):1185–94.CrossRefPubMed
6.
Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J. 1996;312:1254–9.CrossRef
7.
Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164:1108–12.CrossRefPubMed
8.
Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone. 2004;34:195–202.CrossRefPubMed
9.
Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD. Low bone mineral density and fracture burden in postmenopausal women. Can Med Assoc J. 2007;177(6):575–80.CrossRef
10.
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(4):775–87.CrossRefPubMed
11.
Pothuaud L, Barthe N, Krieg MA, Mehsen N, Carceller P, Hans D. 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(2):170–6.CrossRefPubMed
12.
Krueger D, Libber J, Binkley N. Spine trabecular bone score precision, a comparison between GE lunar standard and high-resolution densitometers. J Clin Densitom. 2015;18:226–32.CrossRefPubMed
13.
Leslie WD, Lix L, Morin S, Majumdar S, Hans D. Difference in Spine TBS between men and women: real or technical? J Clin Densitom. 2014;17(3):406–7.CrossRef
14.
15.
Kolta S, Briot K, Fechtenbaum J, Paternotte S, Armbrecht G, Felsenberg D, et al. TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int. 2014;25(6):1759–64.CrossRefPubMed
16.
Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg MA. 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(3):302–12.CrossRefPubMed
17.
Bousson V, Bergot C, Sutter B, Levitz P, Cortet B. Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects. Osteoporos Int. 2012;23(5):1489–501.CrossRefPubMed
18.
Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD. 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.CrossRefPubMed
19.
Roux JP, Wegrzyn J, Boutroy S, Bouxsein ML, Hans D, Chapurlat R. The predictive value of trabecular bone score (TBS) on whole lumbar vertebrae mechanics: an ex vivo study. Osteoporos Int. 2013;24(9):2455–60.CrossRefPubMed
20.
Muschitz C, Kocijan R, Haschka J, Pahr D, Kaider A, Pietschmann P, et al. TBS reflects trabecular microarchitecture in premenopausal women and men with idiopathic osteoporosis and low-traumatic fractures. Bone. 2015;79:259–66.CrossRefPubMed
21.
Maquer G, Lu Y, Dall’Ara E, Chevalier Y, Krause M, Yang L, et al. The initial slope of the variogram, foundation of the trabecular bone score, is not or is poorly associated with vertebral strength. J Bone Miner Res. 2015;. doi:10.​1002/​jbmr.​2610.
22.
Silva BC, Boutroy S, Zhang C, McMahon DJ, Zhou B, Wang J, et al. Trabecular bone score (TBS)—a novel method to evaluate bone microarchitectural texture in patients with primary hyperparathyroidism. J Clin Endocrinol Metab. 2013;98(5):1963–70.PubMedCentralCrossRefPubMed
23.
Popp AW, Buffat H, Eberli U, Lippuner K, Ernst M, Richards RG, et al. Microstructural parameters of bone evaluated using HR-pQCT correlate with the DXA-derived cortical index and the trabecular bone score in a cohort of randomly selected premenopausal women. PLoS One. 2014;9(2):e88946.PubMedCentralCrossRefPubMed
24.
Amstrup A, Jakobsen N, Moser E, Sikjaer T, Mosekilde L, Rejnmark L. Association between bone indices assessed by DXA, HR-pQCT and QCT scans in post-menopausal women. J Bone Miner Metab. 2015;. doi:10.​1007/​s00774-015-0708-9.PubMed
25.
Bousson V, Bergot C, Sutter B, Thomas T, Bendavid S, Benhamou C-L, et al. Trabecular bone score: Where are we now? Joint Bone Spine. 2015;82(5):320–5.CrossRefPubMed
26.
El Hage R, Khairallah W, Bachour F, Issa M, Eid R, et al. Influence of age, morphological characteristics, and lumbar spine bone mineral density on lumbar spine trabecular bone score in Lebanese women. J Clin Densitom. 2014;17:434–5.CrossRefPubMed
27.
28.
Dufour R, Winzenrieth R, Heraud A, Hans D, Mehsen N. Generation and validation of a normative, age-specific reference curve for lumbar spine trabecular bone score (TBS) in French women. Osteoporos Int. 2013;24:2837–46.CrossRefPubMed
29.
Simonelli C, Leib E, Mossman N, Winzenrieth R, Hans D, McClung M. Creation of an age-adjusted, dual-energy x-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in non-Hispanic US White women. J Clin Densitom. 2014;17:314–9.CrossRefPubMed
30.
Iki M, Tamaki J, Sato Y, Winzenrieth R, Fau Kagamimori S, Kagawa Y, et al. Age-related normative values of trabecular bone score (TBS) for Japanese women: the Japanese Population-based Osteoporosis (JPOS) study. Osteoporos Int. 2015;26:245–52.CrossRefPubMed
31.
Sritara C, Thakkinstian A, Ongphiphadhanakul B, Amnuaywattakorn S, Utamakul C, Akrawichien T, et al. Age-adjusted dual X-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in thai females and males. J Clin Densitom. 2015;. doi:10.​1016/​j.​jocd.​2015.​05.​068.
32.
Aloia JF, Mikhail M, Usera G, Dhaliwal R, Islam S. Trabecular bone score (TBS) in postmenopausal African American women. Osteoporos Int. 2015;26(3):1155–61.CrossRefPubMed
33.
McCloskey EV, Oden A, Harvey NC, Leslie WD, Hans D, Johansson H, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res. 2015;. doi:10.​1002/​jbmr.​2734.
34.
Rabier B, Heraud A, Grand-Lenoir C, Winzenrieth R, Hans D. 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(1):176–81.CrossRefPubMed
35.
Leib E, Winzenrieth R, Lamy O, Hans D. Comparing bone microarchitecture by trabecular bone score (TBS) in Caucasian American women with and without osteoporotic fractures. Calcif Tissue Int. 2014;95(3):201–8.CrossRefPubMed
36.
Nassar K, Paternotte S, Kolta S, Fechtenbaum J, Roux C, Briot K. Added value of trabecular bone score over bone mineral density for identification of vertebral fractures in patients with areal bone mineral density in the non-osteoporotic range. Osteoporos Int. 2014;25(1):243–9.CrossRefPubMed
37.
Ayoub ML, Maalouf G, Bachour F, Barakat A, Cortet B, Legroux-Gérot I, et al. DXA-based variables and osteoporotic fractures in Lebanese postmenopausal women. Orthop Traumatol Surg Res. 2014;100(8):855–8.CrossRefPubMed
38.
Touvier J, Winzenrieth R, Johansson H, Roux JP, Chaintreuil J, Toumi H, et al. Fracture discrimination by combined bone mineral density (BMD) and microarchitectural texture analysis. Calcif Tissue Int. 2015;96:274–86.CrossRefPubMed
39.
Hans D, Goertzen AL, Krieg MA, Leslie WD. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res. 2011;26:2762–9.CrossRefPubMed
40.
Boutroy S, Hans D, Sornay-Rendu E, Vilayphiou N, Winzenrieth R, Chapurlat R. Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study. Osteoporos Int. 2013;24(1):77–85.CrossRefPubMed
41.
Briot K, Paternotte S, Kolta S, Eastell R, Reid DM, Felsenberg D, et al. Added value of trabecular bone score to bone mineral density for prediction of osteoporotic fractures in postmenopausal women: the OPUS study. Bone. 2013;57:232–6.CrossRefPubMed
42.
Iki M, Fujita Y, Tamaki J, Kouda K, Yura A, Sato Y, et al. Trabecular bone score may improve FRAX(R) 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.CrossRefPubMed
43.
McCloskey EV, Oden A, Harvey N, Leslie WD, Hans D, Johansson H, et al. Adjusting fracture probability by trabecular bone score. Calcif Tissue Int. 2015;96:500–9.CrossRefPubMed
44.
Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E. FRAX and its applications to clinical practice. Bone. 2009;44:734–43.CrossRefPubMed
45.
Kanis JA, On behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level. Sheffield: World Health Organization Collaborating Centre for Metabolic Bone Diseases; 2007.
46.
Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23:2239–56.PubMedCentralCrossRefPubMed
47.
48.
Giangregorio LM, Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, et al. FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res. 2012;27:301–8.CrossRefPubMed
49.
Schwartz AV, Vittinghoff E, Bauer DC, et al. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA. 2011;305(21):2184–92.PubMedCentralCrossRefPubMed
50.
Leslie WD, Aubry-Rozier B, Lamy O, Hans D. Manitoba bone density P. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab. 2013;98(2):602–9.CrossRefPubMed
51.
Zhukouskaya VV, Ellen-Vainicher C, Gaudio A, Privitera F, Cairoli E, Ulivieri FM, et al. The utility of lumbar spine trabecular bone score and femoral neck bone mineral density for identifying asymptomatic vertebral fractures in well-compensated type 2 diabetic patients. Osteoporos Int. 2016;27(1):49–56. doi:10.​1007/​s00198-015-3212-0.CrossRefPubMed
52.
Dhaliwal R, Cibula D, Ghosh C, Weinstock RS, Moses AM. Bone quality assessment in type 2 diabetes mellitus. Osteoporos Int. 2014;25(7):1969–73.CrossRefPubMed
53.
Paggiosi MA, Peel NF, Eastell R. The impact of glucocorticoid therapy on trabecular bone score in older women. Osteoporos Int. 2015;26:1773–80.CrossRefPubMed
54.
55.
Eller-Vainicher C, Filopanti M, Palmieri S, Ulivieri FM, Morelli V, Zhukouskaya VV, et al. Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism. Eur J Endocrinol. 2013;169(2):155–62.CrossRefPubMed
56.
Romagnoli E, Cipriani C, Nofroni I, Castro C, Angelozzi M, Scarpiello A, et al. “Trabecular Bone Score” (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism. Bone. 2013;53(1):154–9.CrossRefPubMed
57.
Baldini M, Ulivieri FM, Forti S, Serafino S, Seghezzi S, Marcon A, et al. Spine bone texture assessed by trabecular bone score (TBS) to evaluate bone health in thalassemia major. Calcif Tissue Int. 2014;95(6):540–6.CrossRefPubMed
58.
Donaldson AA, Feldman HA, O’Donnell JM, Gopalakrishnan G, Gordon CM. Spinal bone texture assessed by trabecular bone score in adolescent girls with anorexia nervosa. J Clin Endocrinol. 2015;100:3436–42.CrossRef
59.
60.
Kalder M, Kyvernitakis I, Albert US, Baier-Ebert M, Hadji P. Effects of zoledronic acid versus placebo on bone mineral density and bone texture analysis assessed by the trabecular bone score in premenopausal women with breast cancer treatment-induced bone loss: results of the ProBONE II substudy. Osteoporos Int. 2015;26(1):353–60.CrossRefPubMed
61.
Petranova T, Sheytanov I, Monov S, Nestorova R, Rashkov R. Denosumab improves bone mineral density and microarchitecture and reduces bone pain in women with osteoporosis with and without glucocorticoid treatment. Biotechnol Biotechnol Equip. 2014;28:1127–37.PubMedCentralCrossRefPubMed
62.
Di Gregorio S, Del Rio L, Rodriguez-Tolra J, Bonel E, Garcia M, Winzenrieth R. 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.CrossRefPubMed
63.
Bandirali M, Poloni A, Sconfienza L, Messina C, Papini G, Petrini M, 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(7):2194–8.CrossRefPubMed
64.
Shepherd JA, Schousboe JT, Broy SB, Engelke K, Leslie WD. Executive summary of the 2015 ISCD position development conference on advanced measures from DXA and QCT: fracture prediction beyond BMD. J Clin Densitom. 2015;18(3):274–86.CrossRefPubMed
65.
Del Rio LM, Winzenrieth R, Cormier C, Di Gregorio S. 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.CrossRefPubMed
66.
Krueger D, Fidler E, Libber J, Aubry-Rozier B, Hans D, Binkley N. Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women. J Clin Densitom. 2014;17:60–5.CrossRefPubMed
67.
Winzenrieth R, Dufour R, Pothuaud L, Hans D. 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.CrossRefPubMed
68.
Iki M, Tamaki J, Kadowaki E, Sato Y, Dongmei N, Winzenrieth R, 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.CrossRefPubMed
69.
Schousboe JT, Vo T, Taylor BC, Cawthon PM, Schwartz AV, Bauer DC, 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. 2015. doi:10.​1002/​jbmr.​2713.
70.
Popp AW, Meer S, Krieg MA, Perrelet R, Hans D, Lippuner K. Bone mineral density (BMD) and vertebral trabecular bone score (TBS) for the identification of elderly women at high risk for fracture: the SEMOF cohort study. Eur Spine J. 2015. doi:10.​1007/​s00586-015-4035-6.PubMed
Metadata
Title
Clinical Application of Spine Trabecular Bone Score (TBS)
Authors
Neil Binkley
William D. Leslie
Publication date
01-03-2016
Publisher
Springer US
Published in
Clinical & Translational Metabolism / Issue 1/2016
Print ISSN: 1534-8644
Electronic ISSN: 2948-2445
DOI
https://doi.org/10.1007/s12018-016-9203-7

Other articles of this Issue 1/2016

Clinical Reviews in Bone and Mineral Metabolism 1/2016 Go to the issue

Assessment of bone health

Clinical Vignettes: Using Non-BMD Measurements in Clinical Practice

Assessment of bone health

FEA to Measure Bone Strength: A Review

Assessment of bone health

Evaluation of Sarcopenia by DXA

Assessment of bone health

Sarcopenia and Osteoporotic Fractures

Assessment of bone health

Utility of Vertebral Fracture Recognition in Osteoporosis

Assessment of bone health

Introduction: Assessment of Skeletal Health—Beyond Bone Density
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits