Trabecular Bone Score (TBS) shows great value in improving fracture risk prediction of primary and secondary osteoporosis within daily clinical routine in conjunction with DXA BMD. That is particularly true with diseases in Endocrinology such as Diabetes, Acromegaly, Chronic Kidney Disease (CKD), and Hyperparathyroidism.
Trabecular Bone Score (TBS) in hyperparathyroidism (PHPT):
Primary hyperparathyroidism (PHPT) is a common endocrinopathy often accompanied by bone fragility and elevated risk of fracture which is not fully captured by BMD19.
TBS is lower in PHPT patients and associated with vertebral fractures20. TBS helps to identify the PHPT patients that are at risk of fracture20. As such, TBS has been included in the guidelines for the management of Osteoporosis in patients with PHPT6,21.
If you receive a TBS report and you observe that the TBS value is in the red zone in the reference graph section, your patient has a degraded micro architecture suggesting a high risk of fracture, even if he/she was not identified at risk based on the BMD T-score alone.
Feel free to share with your Endocrinologist colleagues, as it might be helpful in identifying more patients at risk for fracture.
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Why Trabecular Bone Score (TBS) adds value in Secondary osteoporosis?
Secondary Osteoporosis is caused by certain medical conditions or treatments that cause alterations of bone strength, involving bone mass and mostly bone microarchitecture deterioration, resulting in bone fragility and fracture. Since BMD only measures bone mass, providing no information on bone microarchitecture, it can underestimate fracture risk and, therefore, it may not be sufficient by itself to determine fracture risk status in these patients.
Trabecular bone score (TBS) is a texture parameter related to bone microarchitecture that provides skeletal information that is not captured from the BMD measurement2. TBS predicts osteoporotic fractures independently of BMD3,4. Added to the FRAX, the TBS’s greatest utility lies in individuals whose BMD levels are close to an intervention threshold (up to 25% of the patients will then be impacted)5. TBS has been included in many local, national, and international medical societies and guidelines 6–11.
You can find more about usage of Trabecular Bone score and fracture risk prediction in Endocrinology below:
• Trabecular Bone Score in Diabetes
• Trabecular Bone Score in Acromegaly
• Trabecular Bone Score in Chronic Kidney Disease (CKD)
• Trabecular Bone Score in Hyperparathyroidism
References for TBS in hyperparathyroidism (PHPT):
- 6. Silva, B. C. et al. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score. J Clin Densitom 18, 309–330 (2015).
- 19. Romagnoli, E. et al. ‘Trabecular Bone Score’ (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism. Bone 53, 154–159 (2013).
- 20. Eller-Vainicher, C. et al. Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism. Eur J Endocrinol 169, 155–162 (2013).
- 21. Bilezikian, J. P. et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J. Clin. Endocrinol. Metab. 99, 3561–3569 (2014).
References for Trabecular Bone Score (TBS Osteo) in Secondary Osteoporosis:
1. Siris, E. S. et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch. Intern. Med. 164, 1108–1112 (2004).
2. Muschitz, C. et al. TBS reflects trabecular microarchitecture in premenopausal women and men with idiopathic osteoporosis and low-traumatic fractures. Bone 79, 259–266 (2015).
3. Hans, D., Goertzen, A. L., Krieg, M.-A. & Leslie, W. D. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J. Bone Miner. Res. 26, 2762–2769 (2011).
4. Iki, M. et al. Trabecular bone score (TBS) predicts vertebral fractures in Japanese women over 10 years independently of bone density and prevalent vertebral deformity: the Japanese Population-Based Osteoporosis (JPOS) cohort study. J Bone Miner Res 29, 399–407 (2014).
5. McCloskey, E. V. et al. A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX. J. Bone Miner. Res. 31, 940–948 (2016).
6. Silva, B. C. et al. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score. J Clin Densitom 18, 309–330 (2015).
7. Harvey, N. C. et al. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone 78, 216–224 (2015).
8. Kanis, J. A., Cooper, C., Rizzoli, R., Reginster, J.-Y. & the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). Executive summary of European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Aging Clin Exp Res (2019) doi:10.1007/s40520-018-1109-4.
9. Briot, K. et al. Actualisation 2018 des recommandations françaises du traitement de l’ostéoporose post-ménopausique. Revue du Rhumatisme 85, (2018).
10. Pfeilschifter, J. [Diagnosing osteoporosis: what is new in the 2014 DVO guideline?]. Dtsch. Med. Wochenschr. 140, 1667–1671 (2015).
11. Naranjo Hernández, A. et al. Recomendaciones de la Sociedad Española de Reumatología sobre osteoporosis. Reumatología Clínica (2018) doi:10.1016/j.reuma.2018.09.004.