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The value of trabecular bone score from DXA images of the lumbar spine

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DOI:10.1038/bonekey.2014.87

Silva et al. review research reporting the use of the trabecular bone score (TBS), as derived from 2-D lumbar spine dual-energy X-ray absorptiometry images (DXA images).

Calculating TBS in this way allows differences to be detected between DXA scans from patients who appear to have very similar bone mineral density (BMD) scores. The higher the TBS value, the better the microstructure of the skeletal bone and the lower the fracture risk. Review data demonstrated that this was true for post-menopausal women and men who had sustained fragility fractures.

TBS values were lower in women whose DXA score did not indicate had either osteoporosis or osteopenia but who had sustained previous fragility fractures. In fact, TBS appeared to be equivalent to BMD measurements at the lumbar spine for predicting fracture risk in postmenopausal women. The authors conclude that this method of measuring lumbar spine TBS could be useful as another too for diagnosing osteoporosis and predicting fracture risk.

Editor’s comment: This paper reviews the pros and cons of computing trabecular bone score (TBS) using coronal DXA projections of the lumbar spine. The advantages of this method include its high precision, the ease of obtaining valuable additional information from standard DXA images and the resulting proliferation of clinical data. Disappointingly, combining areal BMD with TBS generated in this way with did not make predicting the mechanical behaviour of vertebral bone more accurate.

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