Aug 2026· Asian Spine Journal· 0 citations· 29 references
Medicine
Abstract
Study Design
Retrospective sex- and age-matched case-control study.
Purpose
To assess bone mineral density (BMD)-trabecular bone score (TBS) discordance and high-burden abdominal aortic calcification (AAC) in patients with radiographically confirmed osteoporotic vertebral compression fracture (OVCF).
Overview of Literature
Conventional BMD thresholds may fail to identify all patients with vertebral skeletal fragility, as vertebral fractures can occur despite nonosteoporotic BMD. TBS complements BMD by evaluating trabecular microarchitecture, while AAC may serve as a marker of systemic bone-vascular health associated with skeletal fragility.
Methods
This retrospective sex- and age-matched case-control study enrolled patients aged ≥50 years who underwent dual-energy X-ray absorptiometry (DXA) with TBS assessment and vertebral imaging. OVCF was defined as a Genant grade 2 or 3 vertebral fracture. The primary cohort included 47 OVCF patients and 188 matched controls. BMD T-scores at the lumbar spine, femoral neck, total hip, TBS, and AAC-24 were evaluated. Matched conditional logistic regression was used to determine associations with OVCF.
Results
More than half of OVCF patients did not demonstrate osteoporotic BMD at any measured DXA site (53.2%). Among those with nonosteoporotic BMD, low TBS was more common in cases than in controls (48.0% vs. 22.7%). Low TBS remained independently associated with OVCF after adjusting for the lowest BMD T-score and high-burden AAC (odds ratio, 2.66; 95% confidence interval, 1.25-5.63; p =0.011). High-burden AAC was more frequent among cases, although its association was attenuated after adjustment.
Conclusions
Low TBS may aid in identifying vertebral skeletal fragility in OVCF patients with nonosteoporotic BMD on conventional DXA. High-burden AAC may provide vascular information, although its incremental association beyond BMD and TBS was attenuated.
PURPOSE
Bone mineral density (BMD) alone is insufficient to fully capture fracture risk. This study investigated the association between lumbar spine BMD (LS-BMD) and trabecular bone score (TBS) and constructed age- and sex-specific centile reference curves for both measures in a Taiwanese population.
METHODS
This cross-sectional study included 1,196 participants. LS-BMD was measured at L1-L4 by dual-energy X-ray absorptiometry (DXA), and TBS was derived from the same images using TBS iNsight software (Med-Imaps). Pearson correlation and multiple linear regression were performed to examine BMD-TBS associations and identify predictors of TBS variation. Generalized Additive Models for Location, Scale and Shape (GAMLSS) with cubic spline smoothing was applied separately by sex to generate continuous age-specific centile curves (5th-95th percentiles) for ages 20-90 years.
RESULTS
The cohort comprised 530 (44.3%) participants with normal BMD, 493 (41.2%) with osteopenia, and 173 (14.5%) with osteoporosis. LS-BMD and TBS were positively correlated (r = 0.68). LS-BMD, BMI, and age were significant independent predictors of TBS (adjusted R² = 0.672); menopausal status was not. GAMLSS centile curves revealed that female LS-BMD peaked at ages 30-40 years and declined sharply after age 50, while male upper BMD centiles remained stable despite concurrent TBS decline, a BMD-TBS dissociation undetectable by mean-based analyses.
CONCLUSION
LS-BMD and TBS provide complementary information on bone quantity and microarchitectural integrity. The sex-specific GAMLSS-derived centile curves constitute the first full-distribution normative reference standards for LS-BMD and TBS in a Taiwanese population, extending beyond conventional T-score classification.
Li-Chuan Huang, Li-Guo Chen, Ping-An Wu et al.· Journal of clinical densitom...· 0 citations
BACKGROUND/OBJECTIVES
Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and increased fracture risk. Dual-energy X-ray absorptiometry (DXA) is the reference standard for diagnosis, typically assessing the lumbar spine and femoral neck. Site-specific differences may result in spine-hip BMD discordance, potentially influencing clinical decision making. This study aimed to determine the prevalence, patterns, and predictors of spine-hip BMD discordance among Jordanian adults.
METHODS
This retrospective observational study included adults aged ≥18 years who underwent DXA for osteoporosis evaluation at two tertiary hospitals in Jordan between March 2024 and June 2025. Lumbar spine and femoral neck BMD were measured using standardized DXA protocols. Discordance was classified using T-scores or Z-scores as appropriate.
RESULTS
A total of 826 participants were included, comprising 576 evaluated using T-scores and 250 using Z-scores. In the T-score group, lumbar spine-femoral neck BMD discordance was observed in 66.0% of participants, including 50.5% with minor discordance and 15.5% with major discordance, while 34.0% were concordant. In contrast, discordance was present in only 18.4% of the Z-score group. After adjusting for principal demographic and high-prevalence clinical parameters, Multivariable analysis identified family history of osteoporosis and sex as independent predictors of discordance severity in the T-score group, whereas no significant predictors were identified in the Z-score group.
CONCLUSIONS
Spine-hip BMD discordance is common among Jordanian adults undergoing DXA, particularly in those assessed using T-scores, underscoring the importance of multisite DXA assessment to improve diagnostic accuracy and fracture risk evaluation.
Mais Alqoudah, Mu’taz Massad, Zain aldeen Saleh et al.· Journal of clinical densitom...· 0 citations
Bone fragility assessment prior to total hip arthroplasty (THA) is typically based on bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). Meanwhile, prevalent vertebral fracture (VF), an important indicator of bone fragility, may be present even when BMD does not meet the diagnostic criteria for osteoporosis. Although preoperative bone health assessment has become crucial in patients undergoing THA, VFs remain insufficiently evaluated. This study aimed to investigate the prevalence and distribution of DXA-defined osteoporosis and VFs in patients undergoing THA and to evaluate how often DXA alone fails to detect clinically relevant bone fragility. This retrospective observational study included all consecutive patients aged ≥ 45 years who underwent primary THA between January 2021 and December 2025. Those undergoing THA for non-osteoarthritis etiologies were excluded. BMD was measured at the lumbar spine and femoral neck using DXA, and prevalent VFs were assessed on preoperative lateral thoracolumbar radiographs using Genant’s semi-quantitative method. DXA-defined osteoporosis was defined as a T-score ≤ − 2.5 at any measured site. Clinical osteoporosis was defined as DXA-defined osteoporosis and/or VF. The prevalence and distribution of DXA-defined osteoporosis, VF, and their overlap were assessed. Multivariable logistic regression analysis adjusted for age, sex, body mass index, and contralateral hip status was performed to identify factors associated with VF without DXA-defined osteoporosis. Among the 352 included patients, DXA-defined osteoporosis was identified in 84 (23.9%) and VFs in 59 (16.8%). Clinical osteoporosis was observed in 118 patients (33.5%). Of these, 34 patients (9.7% of the total cohort; 28.8% of those with clinical osteoporosis) had VFs without DXA-defined osteoporosis and would not have been identified using DXA alone. Advanced age was independently associated with VF without DXA-defined osteoporosis (adjusted odds ratio, 2.65 per 10-year increase; 95% confidence interval, 1.65–4.24). In patients aged 80 years or older, the prevalence of VF without DXA-defined osteoporosis was 30.6%, and that of clinical osteoporosis was 58.3%. DXA alone underestimated clinically relevant bone fragility in patients undergoing THA. Preoperative radiographic evaluation of VF may improve bone fragility assessment, particularly in older patients.
Yudai Yano, Y. Uchihara, Sachiko Kawasaki et al.· Arthroplasty· 0 citations
Assessment of quantitative MRI and VBQ/modified VBQ into predictive models enables opportunistic, radiation-free screening and more precise fracture risk assessment, bridging the gap between bone quantity and quality for improved prevention and management of fragility fractures.
Sanjith Manian, Arunagiri Gunasekar, Naveen Jeyaraman et al.· World Journal of Methodology· 0 citations
Background and Objectives: Body mass index (BMI) has a complex relationship with skeletal health. Higher BMI is often associated with higher bone mineral density (BMD), but this apparent densitometric advantage may not fully reflect bone microarchitecture. Trabecular bone score (TBS) may provide complementary information in overweight and obese postmenopausal women. This study evaluated the associations between BMI, BMD, and TBS in postmenopausal women and assessed whether increased BMI is associated with discordant skeletal phenotypes characterized by non-osteoporotic densitometric status but impaired trabecular microarchitecture. Materials and Methods: This retrospective observational study screened 110 DXA/TBS reports from patients evaluated in a tertiary DXA center. Inclusion criteria were female sex, postmenopausal status, available BMI or sufficient anthropometric data for BMI calculation, valid lumbar spine DXA, at least one valid hip DXA assessment, and valid lumbar TBS assessment. Four cases were excluded: two male patients and two non-menopausal female patients. The final analytical cohort included 106 postmenopausal women. Lumbar spine and hip BMD, T-scores, TBS, Bone Resilience Index, anthropometric variables, and menopausal variables were extracted from DXA/TBS reports. BMI was analyzed both continuously and by category: under/normal-weight, overweight, and obesity. Correlation analyses, group comparisons, and linear regression models were used to evaluate the relationship between BMI and skeletal parameters. Discordant skeletal phenotypes were defined descriptively as non-osteoporotic DXA findings combined with degraded TBS. Results: The final cohort had a mean age of 65.2 ± 7.6 years and a mean BMI of 27.3 ± 4.5 kg/m2. BMI was positively associated with lumbar spine BMD (r = 0.392, p < 0.001), minimum femoral neck BMD (r = 0.382, p < 0.001), and minimum total hip BMD (r = 0.508, p < 0.001), but negatively associated with TBS (r = −0.307, p = 0.001). Mean TBS decreased across BMI categories, from 1.283 ± 0.084 in the under/normal-weight group to 1.255 ± 0.088 in the overweight group and 1.199 ± 0.109 in the obesity group. In the fully adjusted regression model including BMI, age, years since menopause, lumbar spine BMD, and lowest hip T-score, BMI remained an independent negative predictor of TBS (β = −0.0126, p < 0.001). Discordant skeletal phenotypes combining non-osteoporotic DXA status with degraded TBS were more frequent in patients with obesity. Conclusions: In postmenopausal women, higher BMI was associated with higher BMD but lower TBS, supporting a divergent relationship between densitometric findings and DXA-derived trabecular texture parameters. These findings suggest that TBS may complement BMD in describing skeletal imaging status in overweight and obese women. Because fracture outcomes and complete clinical risk data were not available, the present results should be interpreted as evidence of imaging discordance rather than direct evidence of clinical underdiagnosis or misclassification.
VBQ can serve as an opportunistic exploratory screening marker of low BMD and FBQcsf may complement VBQ by identifying early marrow-related changes, although further validation is required.
M. Müller, João Paulo Colhado Ferreira, Laura Mulazzani Minuzzi Macedo et al.· Skeletal Radiology· 0 citations