Trabecular bone score

The trabecular bone score is a measure of bone texture correlated with bone microarchitecture and a marker for the risk of osteoporosis. Introduced in 2008,[1] its main projected use is alongside measures of bone density in better predicting fracture risk in people with metabolic bone problems.

Need for a marker of microarchitecture
Microarchitecture of bone in health and in osteoporosis.

To diagnose osteoporosis, despite the inclusion of bone mineral density (BMD), biological markers and clinical factors of fracture risk, many not detected patients are at risk and many fractures are not explained. Bone mineral density is an assessment of the quantity of bone. It does not provide information on bone quality, another important parameter to describe the bone. In addition, clinical risk factors for fracture are at best an indirect assessment of the bone quality. One way to describe the quality of the bone is to assess its microarchitecture. Bone microarchitecture is related to the mechanical strength of bone and hence its greater or lesser risk of fracture. Indeed, for the same quantity of bone, different mechanically resistant bone structures may exist (few large trabeculae or numerous thin trabeculae that are mechanically stronger). Actually, bone loss is often accompanied by a deterioration of bone architecture, resulted in a decreased number of trabeculae, increased inter-trabecular distances, and a loss connectivity of the trabecular meshwork. Moreover, reduction of cortical bone thickness and increased porosity accompany trabecular bone loss, and in particular promote the fragility of the femoral neck. Osteoporotic bone is called "porous".

Technical
Relative Risk of TBS expressed by standard deviation and compared with relative risks of major clinical risk factors for fracture

The trabecular bone score is a textural parameter that can be applied to DEXA, which quantifies the local variations in gray level. TBS is derived from the evaluation of the experimental variogram, obtained from the grayscale DEXA.

It was found that TBS is a reflection of the structural condition of the bone microarchitecture. TBS is strongly correlated with the number of trabeculae and their connectivity and negatively with the space between trabeculae.[2][3] That is to say that a high TBS value means that microarchitecture bone is dense, well connected with little spaces between trabeculaes. Conversely, a low TBS value means that the microarchitecture of bone is incomplete and poorly connected with wide spaces between trabeculae.[4]

Clinical use

From a clinical standpoint, TBS provides:

  • assessment the risk of fracture;[5]
  • in combination with BMD, increase the number of patients at risk (correctly) identified;[5][6][7]
  • improvement the management of patients with secondary osteoporosis;[8]
  • follow-up of the evolution of microarchitecture of a patient over time;[4]
  • monitoring of the effect of anti-resorptive or anabolic.

All these studies have shown that TBS can be used as a clinical risk factor for osteoporotic fracture since it is reversible (with or without treatment), quantitative and independent of BMD. It should therefore be used as such in the same way that taking corticosteroids, rheumatoid arthritis or prevalent fracture after age 50.

The FRAX calculator has an option to include TBS for a TBS adjusted FRAX risk score. The calculated probabilities of fracture have been shown to be more accurate when computed including TBS.[9]

As TBS relies on measurement of soft tissue, it is considered unreliable in individuals with a BMI over 37.[10]

Further reading

Notes and references
  1. Pothuaud, Laurent; Carceller, Pascal; Hans, Didier (2008). "Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: Applications in the study of human trabecular bone microarchitecture". Bone. 42 (4): 775–87. doi:10.1016/j.bone.2007.11.018. PMID 18234577.
  2. Hans, Didier; Barthe, Nicole; Boutroy, Stephanie; Pothuaud, Laurent; Winzenrieth, Renaud; Krieg, Marc-Antoine (2011). "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". Journal of Clinical Densitometry. 14 (3): 302–12. doi:10.1016/j.jocd.2011.05.005. PMID 21724435.
  3. Piveteau, Teddy; Winzenrieth, Renaud; Hans, Didier (2011). "Assessment of correlations between 3D μCT microarchitecture parameters and TBS: Effects of resolution and correlation with TBS DXA measurements". Journal of Clinical Densitometry. 14 (2): 169. doi:10.1016/j.jocd.2011.02.056.
  4. Hans, Didier; Goertzen, Andrew L; Krieg, Marc-Antoine; Leslie, William D (2011). "Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: The manitoba study". Journal of Bone and Mineral Research. 26 (11): 2762–9. doi:10.1002/jbmr.499. PMID 21887701.
  5. Pothuaud, Laurent; Barthe, Nicole; Krieg, Marc-Antoine; Mehsen, Nadia; Carceller, Pascal; Hans, Didier (2009). "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". Journal of Clinical Densitometry. 12 (2): 170–6. doi:10.1016/j.jocd.2008.11.006. PMID 19181553.
  6. Winzenrieth, Renaud; Dufour, Rémy; Pothuaud, Laurent; Hans, Didier (2009). "A Retrospective Case–Control Study Assessing the Role of Trabecular Bone Score in Postmenopausal Caucasian Women with Osteopenia: Analyzing the Odds of Vertebral Fracture". Calcified Tissue International. 86 (2): 104–9. doi:10.1007/s00223-009-9322-y. PMID 19998029.
  7. Rio, L. M.; Winzenrieth, R.; Cormier, C.; Gregorio, S. (2012). "Is bone microarchitecture status of the lumbar spine assessed by TBS related to femoral neck fracture? A Spanish case–control study". Osteoporosis International. 24 (3): 991–8. doi:10.1007/s00198-012-2008-8. PMID 22581295.
  8. Eller-Vainicher, Cristina; Morelli, Valentina; Ulivieri, Fabio Massimo; Palmieri, Serena; Zhukouskaya, Volha V.; Cairoli, Elisa; Pino, Rosa; Naccarato, Antonella; Scillitani, Alfredo; Beck-Peccoz, Paolo; Chiodini, Iacopo (2012). "Bone quality, as measured by trabecular bone score (TBS), in patients with adrenal incidentalomas with and without subclinical hypercortisolism". Journal of Bone and Mineral Research. 27 (10): 2223–30. doi:10.1002/jbmr.1648. PMID 22549969.
  9. www.sheffield.ac.uk https://www.sheffield.ac.uk/TBS/index.aspx. Retrieved 2022-09-28. {{cite web}}: Missing or empty |title= (help)
  10. Shevroja, Enisa; Aubry‐Rozier, Bérengère; Hans, Gabriel; Gonzalez‐Rodriguez, Elena; Stoll, Delphine; Lamy, Olivier; Hans, Didier (December 2019). "Clinical Performance of the Updated Trabecular Bone Score (TBS) Algorithm, Which Accounts for the Soft Tissue Thickness: The OsteoLaus Study". Journal of Bone and Mineral Research. 34 (12): 2229–2237. doi:10.1002/jbmr.3851. ISSN 0884-0431.
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