Osteoporosis International

, Volume 26, Issue 1, pp 245–252 | Cite as

Age-related normative values of trabecular bone score (TBS) for Japanese women: the Japanese Population-based Osteoporosis (JPOS) study

  • M. IkiEmail author
  • J. Tamaki
  • Y. Sato
  • R. Winzenrieth
  • S. Kagamimori
  • Y. Kagawa
  • H. Yoneshima
Original Article



Trabecular bone score (TBS), a surrogate measure of bone microarchitecture, represents fracture risk independently of bone density. We present normative TBS values from a representative population study of Japanese women. This database would enhance our understanding of trabecular bone microarchitecture and improve osteoporosis management.


TBS is a texture parameter that quantifies local variation in gray level distribution within dual-energy X-ray absorptiometry (DXA) images of the lumbar spine. While TBS is associated with fracture risk independently of areal bone mineral density (aBMD), normative TBS values have only been reported for Caucasian women. This study provides age-specific normative values of TBS from a representative sample of Japanese women.


We randomly selected 4,550 women aged 15–79 years from 7 areas throughout Japan. Women younger than 20 years and those with any medical history which might affect bone metabolism were excluded, and the remaining 3,069 with at least two assessable vertebrae from the first to the fourth vertebrae were subjected to analysis. TBS values were calculated from spine DXA images using TBS iNsight software (Med-Imaps, France). Age-related models of TBS were constructed using piecewise linear regression analysis.


Participant age, body mass index (BMI), spine aBMD, and TBS (mean ± SD) were 48.7 ± 16.8 years, 22.9 ± 3.4, 0.888 ± 0.169 g/cm2, and 1.187 ± 0.137, respectively. A three-piece linear regression model of TBS on age explained 70.7 % of the total variance in TBS and comprised very small age-related changes in the youngest segment of the regression line, rapid loss in the middle segment, and small loss in the oldest segment. TBS was lower in Japanese women than in Caucasian women across all age ranges, with the difference increasing with age up through 65 years.


The normative values of TBS for Japanese women presented here would enhance our understanding of trabecular bone microarchitecture and help improve the management of osteoporosis.


Bone microarchitecture DXA Japanese women Normative values Osteoporosis Trabecular bone score 



The authors wish to thank the personnel at the health departments of municipalities studied (Miyakojima, Sanuki, Nishi-aizu, Memuro, Joetsu, Iwate, and Kousa) for their excellent support and Toyo Medic Co., Osaka, Japan, and Toyukai Medical Corporation, Tokyo, Japan, for their technical assistance.

This study represents a part of the research conducted by the JPOS study group (Chairman Hideo Yoneshima, MD, PhD, President, Shuwa General Hospital) comprising Fumiaki Marumo (former chairman, Professor Emeritus, Tokyo Medical and Dental University), Toshihisa Matsuzaki (former co-chairman, Professor Emeritus, University of the Ryukyus), Takashi Akiba (Tokyo Women’s Medical University), Etsuko Kajita (Nagoya University School of Health Sciences), Harumi Nishino (Toyama Pharmaceutical Association), Tomoharu Matsukura (Toyama Prefectural Government), Toshio Matsumoto (University of Tokushima Graduate School of Medical Sciences), and Takashi Yamagami (Hokuriku Health Service Association), in addition to the authors.

Financial support for the JPOS baseline study was provided by the Japanese Ministry of Agriculture, Forestries and Fisheries, the Japan Milk Promotion Board, and the Japan Dairy Council. TBS-related studies were financially supported by Grants-in-Aid for Exploratory Research (No. 25670326, 2013–2014) from the Japanese Society for the Promotion of Science.

Conflicts of interest

Renaud Winzenrieth is a senior scientist at Med-Imaps. Masayuki Iki, Junko Tamaki, Yuho Sato, Sadanobu Kagamimori, Yoshiko Kagawa, and Hideo Yoneshima declare that they have no conflicts of interest.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  • M. Iki
    • 1
    Email author
  • J. Tamaki
    • 2
  • Y. Sato
    • 3
  • R. Winzenrieth
    • 4
  • S. Kagamimori
    • 5
  • Y. Kagawa
    • 6
  • H. Yoneshima
    • 7
  1. 1.Department of Public HealthKinki University Faculty of MedicineOsaka-SayamaJapan
  2. 2.Department of Hygiene and Public HealthOsaka Medical CollegeTakatsukiJapan
  3. 3.Department of Human LifeJin-ai UniversityEchizenJapan
  4. 4.Med-Imaps, Hôpital Xavier Arnozan Bordeaux France
  5. 5.University of ToyamaToyamaJapan
  6. 6.Kagawa Nutrition UniversitySakadoJapan
  7. 7.Shuwa General HospitalKasukabeJapan

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