Osteoporosis International

, Volume 23, Issue 5, pp 1489–1501

Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects

  • V. Bousson
  • C. Bergot
  • B. Sutter
  • P. Levitz
  • B. Cortet
  • the Scientific Committee of the GRIO (Groupe de Recherche et d’Information sur les Ostéoporoses)
Review

DOI: 10.1007/s00198-011-1824-6

Cite this article as:
Bousson, V., Bergot, C., Sutter, B. et al. Osteoporos Int (2012) 23: 1489. doi:10.1007/s00198-011-1824-6

Abstract

The diagnosis of osteoporosis rests on areal bone mineral density (BMD) measurement using DXA. Cancellous bone microarchitecture is a key determinant of bone strength but cannot be measured using DXA. To meet the need for a clinical tool capable of assessing bone microarchitecture, the TBS was developed. The TBS is a texture parameter that evaluates pixel gray-level variations in DXA images of the lumbar spine. The TBS variations may reflect bone microarchitecture. We explain the general principles used to compute the TBS, and we report the correlations between TBS and microarchitectural parameters. Several limitations of the TBS as it is used now are pointed out. We discuss data from currently available clinical studies on the ability of the TBS to identify patients with fractures and to evaluate the fracture risk. We conclude that this new index emphasizes the failure of the BMD T-score to fully capture the fragility fracture risk. However, although microarchitecture may influence the TBS, today, to the best of our understanding, there is no sufficient evidence that a TBS measurement provides reliable information on the status of the bone microarchitecture for a given patient. The TBS depends on gray-level variations and in a projectional image obtained in vivo, these variations can have many causes. Nevertheless, as clinical studies suggest that the TBS predicts the risk of fracture even after adjustment for BMD, we are encouraged to learn more about this score. Additional studies will have to be performed to assess the advantages and limitations of the TBS, in order to ensure that it is used appropriately in clinical practice.

Keywords

Bone microarchitectureBone qualityDXAOsteoporosisTrabecular bone

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • V. Bousson
    • 1
    • 2
  • C. Bergot
    • 1
    • 3
  • B. Sutter
    • 4
  • P. Levitz
    • 5
  • B. Cortet
    • 6
  • the Scientific Committee of the GRIO (Groupe de Recherche et d’Information sur les Ostéoporoses)
  1. 1.Faculté de Médecine Lariboisière-Saint Louis, Laboratoire de Radiologie Expérimentale, CNRS UMR 7052Université Paris VIIParisFrance
  2. 2.Service de Radiologie OstéoArticulaireAssistance Publique-Hôpitaux de Paris, Hôpital LariboisièreParisFrance
  3. 3.Service de Radiologie, Assistance Publique-Hôpitaux de ParisHôpital Saint-LouisParisFrance
  4. 4.Unité de Médecine Nucléaire, Institut Calot, Groupe HOPALEBerck/Mer CedexFrance
  5. 5.PMC-CNRSEcole PolytechniquePalaiseauFrance
  6. 6.Service de RhumatologieHôpital Roger SalengroLille CedexFrance