Endocrine

, Volume 47, Issue 2, pp 435–448

Utility of the trabecular bone score (TBS) in secondary osteoporosis

  • Fabio M. Ulivieri
  • Barbara C. Silva
  • Francesco Sardanelli
  • Didier Hans
  • John P. Bilezikian
  • Renata Caudarella
Endocrine Methods and Techniques

DOI: 10.1007/s12020-014-0280-4

Cite this article as:
Ulivieri, F.M., Silva, B.C., Sardanelli, F. et al. Endocrine (2014) 47: 435. doi:10.1007/s12020-014-0280-4

Abstract

Altered bone micro-architecture is an important factor in accounting for fragility fractures. Until recently, it has not been possible to gain information about skeletal microstructure in a way that is clinically feasible. Bone biopsy is essentially a research tool. High-resolution peripheral Quantitative Computed Tomography, while non-invasive, is available only sparsely throughout the world. The trabecular bone score (TBS) is an imaging technology adapted directly from the Dual Energy X-Ray Absorptiometry (DXA) image of the lumbar spine. Thus, it is potentially readily and widely available. In recent years, a large number of studies have demonstrated that TBS is significantly associated with direct measurements of bone micro-architecture, predicts current and future fragility fractures in primary osteoporosis, and may be a useful adjunct to BMD for fracture detection and prediction. In this review, we summarize its potential utility in secondary causes of osteoporosis. In some situations, like glucocorticoid-induced osteoporosis and in diabetes mellitus, the TBS appears to out-perform DXA. It also has apparent value in numerous other disorders associated with diminished bone health, including primary hyperparathyroidism, androgen-deficiency, hormone-receptor positive breast cancer treatment, chronic kidney disease, hemochromatosis, and autoimmune disorders like rheumatoid arthritis. Further research is both needed and warranted to more clearly establish the role of TBS in these and other disorders that adversely affect bone.

Keywords

Secondary osteoporosisTrabecular bone scoreBone qualityGlucocorticoidsPrimary hyperparathyroidismRheumatoid arthritisChronic kidney diseaseDiabetes mellitus

Abbreviations

2D

Two-dimensional

3D

Three-dimensional

AUC

Area under the curve

BMD

Bone mineral density

BMI

Body mass index

Conn.D

Connectivity density

CT

Computed tomography

DXA

Dual energy X-ray absorptiometry

FEA

Finite element analysis

FEXI

Finite element analysis of X-ray images

FN

Femoral neck

GC

Glucocorticoids

LS

Lumbar spine

MRI

Magnetic resonance imaging

OR

Odds ratio

ROC

Receiver operating characteristic

SD

Standard deviation

TBS

Trabecular bone score

TH

Total hip

Tb.N

Trabecular number

Tb.Sp

Trabecular spacing

Tb.Th

Trabecular thickness

WHO

World Health Organization

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Fabio M. Ulivieri
    • 1
  • Barbara C. Silva
    • 2
  • Francesco Sardanelli
    • 3
  • Didier Hans
    • 4
  • John P. Bilezikian
    • 2
  • Renata Caudarella
    • 5
  1. 1.Bone Metabolic Unit, Division of Nuclear MedicineFondazione Irccs Ca’ Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.Radiologiy Unit, IRCCS Policlinico San Donato, Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
  4. 4.Center of Bone Diseases, Division of Rheumatology, Department of Bones and JointsLausanne University HospitalLausanneSwitzerland
  5. 5.Maria Cecilia Hospital GVM Care and ResearchCotignolaItaly