Association of trabecular bone score (TBS) and prior fracture differs
among minorities in NHANES 2005-2008
R. K. Jain
Received: 9 January 2018 /Accepted: 21 May 2018
International Osteoporosis Foundation and National Osteoporosis Foundation 2018
Summary The study investigates the association of trabecular bone score (TBS) and fractures among minority populations. In
NHANES 2005-2008, TBS was associated with history of fractures in Caucasian subjects but demonstrated somewhat weaker
associations in African American and Mexican American women.
Introduction Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA image, predicts fractures well in
Caucasian (CA) and Asian populations but is less well studied in African American (AA) and Mexican American (MA) subjects.
It is not clear whether TBS is associated with or is predictive of fragility in these racial/ethnic groups.
Methods We analyzed data from subjects from NHANES 2005-2008 over the age of 40 who had TBS: 1178 CA, 467 AA, and
397 MA women and 1200 CA, 502 AA, and 386 MA men. TBS was categorized into normal, ≥ 1.310, partially degraded <
1.310, and > 1.230, or degraded, ≤ 1.230. History of fracture was assessed by questionnaire.
Results Among women, there was an increasing prevalence of fracture with worsening TBS category. However, when control-
ling for age, BMI, and low T-score, the association between TBS category and previous fracture was only significant in CA
women (OR 1.49 per worsening category, 95% CI 1.20–1.85). In men, there was also an increase in the prevalence of fracture
with worsening TBS category in all races/ethnicities. When controlling for age, BMI, and low T-score, the association between
TBS category and previous fracture was only significant in CA men (OR 1.47 per worsening category, 95% CI 1.10–1.95),
though analysis was somewhat limited by small fracture numbers.
Conclusions The association of fracture and TBS varies by race/ethnicity and gender with weaker association observed in AA
and MA women. More research is needed to define the proper use of TBS for predicting fractures in minority groups.
Keywords African American
Trabecular bone score
Osteoporosis is a devastating disease and leads to nine million
fragility fractures worldwide per year . While bone mineral
density (BMD) can help identify many of those at risk, over
50% of fractures will occur in patients without Bosteoporosis^
on BMD testing [2, 3]. Recently, trabecular bone score (TBS)
has been developed as an adjunct to BMD to aid in refining
fracture risk . TBS assesses the texture of the lumbar spine
DXA image and correlates with measures of bone
microarchitecture . It has been shown to predict fracture
risk in studies across North America, Europe, Australia, and
Asia . Because of this predictive ability, TBS has been
incorporated into the Internal Society of Clinical
Densitometry (ISCD) guidelines , suggested as a comple-
mentary measure in diabetes mellitus [8, 9], and even added
directly into the Fracture Risk Assessment tool (FRAX) to
modulate the estimates of fracture probability .
However, while TBS has been well studied in Caucasians
and Asians, it is less well studied in other ethnic groups.
Studies noted above were not primarily based in the USA
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00198-018-4584-8) contains supplementary
material, which is available to authorized users.
* R. K. Jain
Section of Metabolism, Diabetes, and Endocrinology, Lewis Katz
School of Medicine at Temple University, 3322 N Broad St, Ste 205,
Philadelphia, PA 19140, USA
Section of Endocrinology, Diabetes, and Metabolism, University of
Chicago Medicine, Chicago, IL 60611, USA