A Retrospective Case–Control Study Assessing the Role of Trabecular Bone Score in Postmenopausal Caucasian Women with Osteopenia: Analyzing the Odds of Vertebral Fracture

This case–control study assessed whether the trabecular bone score (TBS), determined from gray-level analysis of DXA images, might be of any diagnostic value, either alone or combined with bone mineral density (BMD), in the assessment of vertebral fracture risk among postmenopausal women with osteopenia. Of 243 postmenopausal Caucasian women, 50–80 years old, with BMD T-scores between –1.0 and –2.5, we identified 81 with osteoporosis-related vertebral fractures and compared them with 162 age-matched controls without fractures. Primary outcomes were BMD and TBS. For BMD, each incremental decrease in BMD was associated with an OR = 1.54 (95% CI = 1.17–2.03), and the AUC was 0.614 (0.550–0.676). For TBS, corresponding values were 2.53 (1.82–3.53) and 0.721 (0.660–0.777). The difference in the AUC for TBS vs. BMD was statistically significant (p = 0.020). The OR for (TBS + BMD) was 2.54 (1.86–3.47) and the AUC 0.732 (0.672–0.787). In conclusion, the TBS warrants a closer look to see whether it may be of clinical usefulness in the determination of fracture risk in postmenopausal osteopenic women.