Update on trabecular bone score

Trabecular bone score (TBS) is an indirect and noninvasive measure of bone quality. A lowTBS indi-cates degraded bone microarchitecture, predicts osteoporotic fracture, and is partially independent of clinical risk factors and bone mineral density (BMD). There is substantial evidence supporting the use ofTBS to assess vertebral, hip, and major osteoporotic fracture risk in postmenopausal women, as well as to assess hip and major osteoporotic fracture risk in men aged > 50 years. TBS comple-ments BMD information and can be used to adjust the FRAX (Fracture Risk Assessment) score to improve risk stratification. WhileTBS should not be used to monitor antiresorptive therapy, it may be potentially useful for monitoring anabolic therapy.There is also a growing body of evidence indicat-ing thatTBS is particularly useful as an adjunct to BMD for fracture risk assessment in conditions as-sociated with increased fracture risk, such as type-2 diabetes, chronic corticosteroid excess, and other conditions wherein BMD readings are often misleading. The interference of abdominal soft tissue thickness (STT) on TBS should also be considered when interpreting these findings because image noise can impactTBS evaluation. A new TBS software version based on an algorithm that accounts for STT rather than BMI seems to correct this technical limitation and is under development. In this paper, we review the current state of TBS, its technical aspects, and its evolving role in the assess-ment and management of several clinical conditions. Arch Endocrinol Metab. 2022;66(5):694-706

Automated summary

Trabecular bone score (TBS) is an indirect and noninvasive measure of bone quality that can predict osteoporotic fracture risk and assist in the evaluation and management of various clinical conditions. TBS complements bone mineral density (BMD) information and can adjust the FRAX score to improve risk stratification. TBS is particularly useful as an adjunct to BMD in conditions associated with increased fracture risk.