TBS iNsightTM: A New Tool to Identify Patients at Increased Risk of Fracture

TBS iNsight is a software tool that installs on existing DXA scanners. It is a simple, rapid and reproducible method that estimates fracture risk based on a determination of bone texture (an index correlated to bone microarchitecture),1,2 in addition to risks determined by DXA bone mineral density and clinical risk factors. The result is expressed as a Trabecular Bone Score (TBS). Although bone mineral density (BMD) measured by DXA is a major determinant of bone strength and fracture risk, it is well known that over 50% of fractures occur in patients with BMD values that are not classified as “osteoporotic” (Figure 1).3 This observation means that factors other than BMD influence bone strength and fracture risk, including microarchitectural deterioration of bone tissue as implied from the conceptual definition of osteoporosis. Additional skeletal and extra-skeletal factors such as bone geometry, micro-damage, mineralization, bone turnover, age, family history, and fall risk contribute to the overall fracture risk.4




  1. Winzenrieth R, et al, Three-Dimensional (3D) Microarchitecture Correlations with 2D Projection Image Gray-Level Variations Assessed by Trabecular Bone Score Using High-Resolution Computed Tomographic Acquisitions: Effects of Resolution and Noise. J Clin Densitom. 2013 Jul-Sep; 16(3):287-96.
  2. Hans D, et al, 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 Jul-Sep; 14(3):302-12.
  3. Siris ES, et al, Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004 May 24;164 (10):1108-12.
  4. Burr DB. Bone material properties and mineral matrix contributions to fracture risk or age in women and men. J Musculoskelet Neuronal Interact. 2002 Mar;2 (3):201-4.