A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX.
Journal article, 2016

Trabecular bone score (TBS) is a grey-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a BMD-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables and outcomes during follow up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% CI: 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR 1.32, 95%CI: 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95%CI: 1.65, 1.87 vs. 1.70, 95%CI: 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. This article is protected by copyright. All rights reserved.


Eugene V McCloskey

Nicholas C Harvey

William D Leslie

Didier Hans

Helena Johansson

Reinhard Barkmann

Stephanie Boutroy

Jacques Brown

Roland Chapurlat

Petra Jm Elders

Yuki Fujita

Claus-C Glüer

David Goltzman

Masayuki Iki

Magnus Karlsson

Andreas Kindmark

Mark Kotowicz

Norio Kurumatani

Timothy Kwok

Oliver Lamy

Jason Leung

Kurt Lippuner

Östen Ljunggren

Mattias Lorentzon

University of Gothenburg

Dan Mellström

University of Gothenburg

Thomas Merlijn

Ling Oei

Claes Ohlsson

University of Gothenburg

Julie A Pasco

Fernando Rivadeneira

Björn Rosengren

Elisabeth Sornay-Rendu

Pawel Szulc

Junko Tamaki

John A Kanis

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

1523-4681 (ISSN)

Vol. 31 5 940-948

Subject Categories

Endocrinology and Diabetes





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