Messina, Carmelo; Poloni, Alessandro; Chianca, Vito; Albano, Domenico; Piodi, Luca Petruccio; Ulivieri, Fabio Massimo; Sconfienza, Luca Maria
PurposeTrabecular Bone Score (TBS) provides an indirect score of trabecular microarchitecture from lumbar spine (LS) dual energy X-ray absorptiometry. Increasing soft tissue thickness artifactually reduces TBS values, we evaluated the effect of a fictitious increase of soft tissue thickness on TBS and bone mineral density (BMD) reproducibility on a phantom model.MethodsA Hologic spine phantom was scanned with a QDR-Discovery W Hologic densitometer. Fresh pork rind layers of 5 mm were used to simulate the in-vivo soft tissues. For each scan mode (fast array [FA], array, high definition [HD]), 25 scans were consecutively performed without phantom repositioning, at 0 (no layers), 1 cm, 3 cm, and 6 cm of thickness. BMD and TBS reproducibility was calculated as the complement to 100% of least significant change.ResultsBoth BMD and TBS reproducibility slightly decreased with increasing soft tissue, this difference was statistically significant only for BMD using HD modality (reproducibility decreased from 99.4% at baseline to 98.4% at 6-cm of thickness). TBS reproducibility was slightly lower compared to that of BMD, and ranged between 98.8% (array, 0 cm) and 97.4% (FA, 6 cm). Without taking into account manufacturer BMI optimization, we found a progressive decrease of TBS mean values with increasing soft tissue thickness. The highest TBS difference between baseline scan and 6 cm was −0.179 (−14.27%) using HD.ConclusionsDespite being slightly lower than that of BMD, TBS reproducibility was not affected up to 6 cm of increasing soft tissue thickness, and was even less influenced by fat than BMD reproducibility.