Osteoporosis International

, Volume 24, Issue 3, pp 991–998 | Cite as

Is bone microarchitecture status of the lumbar spine assessed by TBS related to femoral neck fracture? A Spanish case–control study

  • L. M. Del Rio
  • R. Winzenrieth
  • C. Cormier
  • S. Di Gregorio
Original Article



Bone mineral density (BMD) as assessed by dual energy X-ray absorptiometry (DXA) constitutes the gold standard for osteoporosis diagnosis. However, DXA does not take into account bone microarchitecture alterations.


The aim of our study was to evaluate the ability of trabecular bone score (TBS) at lumbar spine to discriminate subjects with hip fracture.


We presented a case–control study of 191 Spanish women aged 50 years and older. Women presented transcervical fractures only. BMD was measured at lumbar spine (LS-BMD) using a Prodigy densitometer. TBS was calculated directly on the same spine image. Descriptive statistics, tests of difference and univariate and multivariate backward regressions were used. Odds ratio (OR) and the ROC curve area of discriminating parameters were calculated.


The study population consisted of 83 subjects with a fracture and 108 control subjects. Significant lower spine and hip BMD and TBS values were found for subjects with fractures (p < 0.0001). Correlation between LS-BMD and spine TBS was modest (r = 0.41, p < 0.05). LS-BMD and TBS independently discriminate fractures equally well (OR = 2.21 [1.56–3.13] and 2.05 [1.45–2.89], respectively) but remain lower than BMD at neck or at total femur (OR = 5.86 [3.39–10.14] and 6.06 [3.55–10.34], respectively). After adjusting for age, LS-BMD and TBS remain significant for transcervical fracture discrimination (OR = 1.94 [1.35–2.79] and 1.71 [1.15–2.55], respectively). TBS and LS-BMD combination (OR = 2.39[1.70-3.37]) improved fracture risk prediction by 25 %.


This study shows the potential of TBS to discriminate subjects with and without hip fracture. TBS and LS-BMD combination improves fracture risk prediction. Nevertheless, BMD at hip remains the best predictor of hip fracture.


Bone microarchitecture Bone mineral density Hip fracture TBS (trabecular bone score) 



We would like to give special thanks to Helene Ward for orthographic and grammatical corrections of the manuscript.

Conflicts of interest

Renaud Winzenrieth was a consultant for Med-Imaps.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • L. M. Del Rio
    • 1
  • R. Winzenrieth
    • 2
    • 4
  • C. Cormier
    • 3
  • S. Di Gregorio
    • 1
  1. 1.CETIR Grup MèdicBarcelonaSpain
  2. 2.Med-Imaps-Plateforme Technologique d’Innovation Biomédicale (PTIB)Hôpital Xavier ArnozanPessacFrance
  3. 3.Service de Rheumatology A, Hospital CochinAPHPParisFrance
  4. 4.Research Department, Med-Imaps, PTIBHôpital X. ArnozanPessacFrance

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