Consensus of experts of the Russian Osteoporosis Association on the use of trabecular bone index in clinical practice

Traditionally, the assessment of fracture risk is based on measuring bone mineral density using dual-energy X-ray absorptiometry (densitometry). However, more than half of cases of low-energy fractures occur in patients with osteopenia or even normal BMD. The reason is that in addition to the bone mass, its microarchitecture is also important, which is not evaluated by standard densitometry. The trabecular bone score is a non-invasive, indirectly obtained indicator that characterizes the condition of trabecular bone tissue. It is determined by textural analysis of the image obtained during standard DXA of the lumbar spine in a direct projection. High values correspond to a well-organized, robust trabecular bone structure, while low values indicate a pronounced degradation of the microarchitecture. The trabecular bone score serves as an independent predictor of a decrease in bone strength, and combined with bone mineral density, it allows to more accurately predict fracture risk than each of these values separately. The score makes it possible to clarify the risk of both primary and secondary osteoporosis, and in clinical practice it is used as an additional parameter in assessing the risk of osteoporosis and fractures.

Based on the literature data and their own experience, the experts of the Russian Association on Osteoporosis have formulated recommendations on the use of the trabecular bone score in clinical practice to more accurately determine the individual risk of fracture within the framework of personalized medicine.

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3. Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res. 2014 Mar;29(3):518-30. doi: 10.1002/jbmr.2176. Erratum in: J Bone Miner Res. 2017 Nov;32(11):2319. doi: 10.1002/jbmr.3218].

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5. McCloskey EV, Odén A, Harvey NC, Leslie WD, Hans D, Johansson H, Barkmann R, Boutroy S, Brown J, Chapurlat R, Elders PJM, Fujita Y, Glüer CC, Goltzman D, Iki M, Karlsson M, Kindmark A, Kotowicz M, Kurumatani N, Kwok T, Lamy O, Leung J, Lippuner K, Ljunggren Ö, Lorentzon M, Mellström D, Merlijn T, Oei L, Ohlsson C, Pasco JA, Rivadeneira F, Rosengren B, Sornay-Rendu E, Szulc P, Tamaki J, Kanis JA. A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX. J Bone Miner Res. 2016 May;31(5):940-8. doi: 10.1002/jbmr.2734

6. Binkley N, Krueger D, Leslie WD. Accurate Weight and Height Measurement is Essential for Correct Trabecular Bone Score Determination. J Clin Densitom. 2023 Jan-Mar;26(1):52-54. doi: 10.1016/j.jocd.2022.11.003. Epub 2022 Nov 25. PMID: 36470791

7. Goel H, Binkley N, Hans D, Leslie WD. Fracture risk gradient assessed by categories of bone mineral density and trabecular bone score: the Manitoba BMD Registry. Arch Osteoporos. 2023 May 22;18(1):73. doi: 10.1007/s11657-023-01284-0. PMID: 37213026

8. Shevroja E, Reginster JY, Lamy O, Al-Daghri N, Chandran M, Demoux-Baiada AL, Kohlmeier L, Lecart MP, Messina D, Camargos BM, Payer J, Tuzun S, Veronese N, Cooper C, McCloskey EV, Harvey NC. Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging. Osteoporos Int. 2023 Sep;34(9):1501-1529. doi: 10.1007/s00198-023-06817-4

9. Leslie WD, Hans D, Silva BC. Fracture Prediction from Trabecular Bone Score is Unaffected by Anti-Resorptive Treatment: A Registry-Based Cohort Study. J Clin Densitom. 2023 Jan-Mar;26(1):10-15. doi: 10.1016/j.jocd.2023.01.001

10. Belaya ZE, Hans D, Rozhinskaya LY, Dragunova NV, Sasonova NI, Solodovnikov AG, Tsoriev TT, Dzeranova LK, Melnichenko GA, Dedov II. The risk factors for fractures and trabecular bone-score value in patients with endogenous Cushing's syndrome. Arch Osteoporos. 2015;10:44. doi: 10.1007/s11657-015-0244-1.

11. Сlinical Guidelines «Оsteoporosis» https://cr.minzdrav.gov.ru/preview-cr/87_5

12. Belaya Z, Rozhinskaya L, Dedov I, Drapkina O, Fadeev V, Golounina O, Lesnyak O, Mamedova E, Melnichenko G, Petraikin A, Rodionova S, Skripnikova I, Tkacheva O, Toroptsova N, Yureneva S, Kanis JA. A summary of the Russian clinical guidelines on the diagnosis and treatment of osteoporosis. Osteoporos Int. 2023 Mar;34(3):429-447. doi: 10.1007/s00198-022-06667-6.