Focus of the Report: The focus of this Health Technology Assessment is evaluation of the effectiveness and safety of the trabecular bone score (TBS) as an adjunct to bone mineral density (BMD) measurement and/or other validated tools incorporating patient information for prediction of fracture risk and guidance of preventive treatment in postmenopausal women.

Technology Description: Trabecular bone score (TBS) is calculated with proprietary software called TBS iNsight (Medimaps Group) and represents a measure of bone microarchitecture quality. The TBS value is derived from imaging data produced by a standard lumbar spine dual-energy x-ray absorptiometry (DXA) scan. TBS is not intended to replace BMD measurements or scores derived from fracture risk tools but rather to add complementary information and thereby improve risk assessment, treatment selection, and treatment monitoring. TBS is correlated with 3-dimensional bone microarchitecture parameters independent of its correlation with BMD. Lower TBS values are associated with previous fragility (osteoporosis-related) fracture regardless of whether BMD values meet the diagnostic criteria for osteoporosis or osteopenia.

Controversy: The accuracy of DXA-determined BMD for prediction of fracture risk is limited by the complex relationship between various bone characteristics and overall susceptibility to fragility fracture. Factors other than BMD that can influence fracture risk include bone size, aspects of bone quality (e.g., microarchitecture of trabecular bone), microgeometry of cortical bone, bone metabolic activity (turnover), and composition of the mineralized protein matrix.

Key Questions:

  • Does the trabecular bone score (TBS) score, in combination with dual-energy x-ray absorptiometry (DXA)-determined bone mineral density (BMD) or a fracture risk score, improve the accuracy of fragility fracture prediction in postmenopausal women?

  • Does consideration of the TBS score, in combination with DXA-determined BMD or a fracture risk score, change treatment decisions and improve health outcomes?

  • Is measurement of the TBS safe?

  • Have definitive patient selection criteria been identified for use of the TBS?

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