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Bone density and trabecular bone score to predict fractures in adults aged 20–39 years: a registry-based study

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Abstract

Summary

Trabecular bone score (TBS) enhances fracture risk assessment in older adults; whether this is true in younger people is uncertain. In this registry-based study of adults aged 20–39 years, low BMD, but not low TBS, predicted fracture.

Purpose

Trabecular bone score (TBS), a bone texture measurement, is associated with fracture risk independent of bone mineral density (BMD) in older adults. In adults aged 20–40 years, TBS remains stable and its role in fracture risk assessment is unclear. We utilized the Manitoba Bone Density Registry to explore the relationship of fracture risk with BMD and TBS in younger adults.

Methods

Women and men aged 20–39 years referred for DXA testing were studied. Incident major and any fractures were captured from health records. Categories based on WHO BMD T-score classification and TBS tertile were considered using Cox regression models to estimate covariate-adjusted (including sex) hazard ratios (aHR, 95%CI) for incident fracture by category, and each SD decrement in BMD and TBS.

Results

The study included 2799 individuals (77% female, mean age 32 years). Mean (SD) minimum T-score was − 0.9 (1.1) and TBS 1.355 (0.114); 7% had osteoporosis and 13% were in the lowest TBS tertile. Incident major osteoporotic fracture (MOF) and any fracture risk was elevated in those with osteopenia (aHRs 1.20/1.45) and osteoporosis (aHRs 4.60/5.16). Fracture risk was unrelated to TBS tertile. Each SD decrement in BMD was associated with increased MOF risk (aHR 1.64) and any fracture (aHR 1.71); lower TBS was unrelated to fractures.

Conclusion

In young adults, low BMD, but not low TBS, was predictive of MOF and any fracture. Routine clinical TBS measurement is not recommended for young adults. Further study is indicated to evaluate whether TBS is beneficial in subsets of younger adults.

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

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Authors and Affiliations

  1. CentraCare, 1900 CentraCare Circle, St. Cloud, MN, 56303, USA

    Heenam Goel

  2. University of Wisconsin, Madison, WI, USA

    Neil Binkley

  3. Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland

    Didier Hans

  4. University of Manitoba, Winnipeg, CA, USA

    William D. Leslie

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  1. Heenam Goel
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  2. Neil Binkley
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  3. Didier Hans
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  4. William D. Leslie
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Correspondence to Heenam Goel.

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Conflicts of interest

Heenam Goel and William Leslie declare no conflict of interest. Neil Binkley declares no conflict of interest for the content of this paper; research funding from Radius; consultant Amgen. Didier Hans: co-ownership in the TBS patent. Stock options or royalties: MedImaps. Research grants: Amgen, Agnovos, GE Healthcare.

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Goel, H., Binkley, N., Hans, D. et al. Bone density and trabecular bone score to predict fractures in adults aged 20–39 years: a registry-based study. Osteoporos Int 34, 1085–1091 (2023). https://doi.org/10.1007/s00198-023-06722-w

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  • DOI: https://doi.org/10.1007/s00198-023-06722-w

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