Enhanced bone quality assessment through trabecular bone score and bone mineral density in lumbar spine.

Age-specific reference values for lumbar spine trabecular bone score (TBS) in Brazilian adult women.

OBJECTIVE To evaluate age-related changes in lumbar spine trabecular bone microarchitecture using the trabecular bone score (TBS) and to establish age-specific reference values for healthy Brazilian women. METHODS In this cross-sectional study, we evaluated 527 healthy adult women aged 20-82 years recruited as a convenience sample from hospital employees and their relatives. Lumbar spine TBS and bone mineral density (BMD) were obtained from a Hologic Discovery A DXA system using TBS iNsight software (v3.0.3). Primary analyses were restricted to BMI 15-37 kg/m2 and excluded current menopausal hormone therapy users, with sensitivity analyses including these participants. Women were stratified by age decade; menopause-centered analyses were additionally performed using years since menopause, and nonlinearity was explored using restricted cubic splines. RESULTS In the primary analytical sample (n=477), TBS was independently associated with age after adjustment for height and weight (β=-0.004 per year, P<0.001). Among postmenopausal women, years since menopause was independently associated with lower TBS (β=-0.002 per year, P=0.010). Menopausal status and the age-by-menopausal status interaction were not independently associated with TBS. TBS declined earlier across age decades than BMD T-scores, and sensitivity analyses including hormone therapy users yielded similar results. Using the reference distribution from premenopausal women aged 20-39 years, TBS cutoffs were 1.365 for normal microarchitecture and 1.248 for degraded microarchitecture, with intermediate values indicating partially degraded microarchitecture. A substantial proportion of women with normal BMD showed impaired trabecular microarchitecture by TBS, ranging from 34.8% to 41.6% across skeletal sites. CONCLUSIONS This study provides the first age-specific normative TBS reference data for Brazilian women. The findings indicate that trabecular microarchitecture deteriorates earlier and more rapidly with aging than bone mass loss captured by BMD, supporting the use of TBS as a complementary tool for evaluating skeletal health and fracture risk.

Trabecular bone score and bone mineral density in systemic sclerosis: Prevalence of low bone quality and associated clinical factors - a case-control study.

BACKGROUND Systemic sclerosis (SSc) is associated with multifactorial bone loss and elevated vertebral fracture risk. Dual-energy X-ray absorptiometry (DXA) measures areal bone mineral density (aBMD), which reflects bone mass rather than bone strength and provides no information on trabecular microarchitecture. The trabecular bone score (TBS) provides complementary, indirect information on trabecular microarchitecture that may be independently impaired in SSc. The clinical determinants of low TBS and its relationship to vertebral fractures in SSc remain incompletely characterized. OBJECTIVES To compare TBS and BMD between SSc patients and age- and sex-matched healthy controls, overall and separately in women and men; to identify clinical factors independently associated with low TBS in SSc; and to describe vertebral fracture prevalence at 5-year radiographic follow-up. METHODS A case-control study enrolled 130 adult SSc patients and 390 age- and sex-matched healthy controls at Srinagarind Hospital, Khon Kaen University, Thailand. All participants underwent lumbar spine DXA with TBS analysis on the same densitometer. Matched comparisons of continuous outcomes used generalized estimating equations with exchangeable working correlation within matched set; matched comparisons of binary outcomes used conditional logistic regression stratified on matched set. Effect modification by sex was assessed with formal SSc-by-sex interaction terms. Factors associated with low TBS (TBS <1.350) were examined by univariate and multivariable logistic regression, with odds ratios, confidence intervals and p-values derived from the same model. Vertebral fractures were graded by Genant's semiquantitative method at 5-year follow-up in 80 patients with radiographs; after pre-analysis exclusion of two patients with tuberculous vertebral destruction, 78 patients contributed to the fracture analysis. RESULTS Low TBS was significantly more prevalent in SSc patients than controls (53.1% vs. 34.1%, p < 0.001). Mean BMD was significantly lower at all skeletal sites in SSc patients (all p < 0.001). The excess of low TBS in SSc was significant in women (63.2%vs. 37.9% of controls; OR 3.77, 95% CI 2.13-6.69) but not in men (25.7%vs. 23.8%; OR 1.12, 95% CI 0.45-2.78), and the SSc-by-sex interaction was statistically significant, albeit marginally (p=0.047 for continuous TBS; interaction OR 3.38, 95% CI 1.15-9.95, p=0.027 for low TBS). Deficits persisted after BMI adjustment. Within SSc patients, age ≥60 years (adjusted OR 3.99, 95% CI 1.63-9.72; p = 0.002) and female sex (adjusted OR 5.29, 95% CI 2.12-13.18; p < 0.001) were each independently associated with low TBS, and both remained so under Firth penalized-likelihood estimation. Among the 78 evaluable patients, vertebral fracture prevalence at 5-year follow-up was 42.3% (95% CI 32.0-53.4%); fractures occurred across all BMD and TBS categories, including in 8 of 20 patients (40%) with both normal BMD and normal TBS. Of 35 patients meeting the T-score criterion for osteoporosis, 11 (31.4%) received no anti-osteoporotic treatment. CONCLUSIONS SSc patients exhibit significantly impaired bone microarchitecture compared with matched controls. Age and female sex were each independently associated with low TBS, and the microarchitectural deficit relative to controls was more marked in women, though the male subgroup was small and the interaction evidence marginal. TBS may provide information complementary to BMD in SSc, and its role in fracture risk stratification warrants prospective evaluation. The high vertebral fracture prevalence and the substantial treatment gap identify priorities for bone health care in SSc.

Trabecular bone score beyond bone mineral density for identifying osteoporotic vertebral compression fractures: a matched case-control study.

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.

A cross-sectional study underlying the sex-stratified associations between muscle strength and bone mineral density among children and adolescents.

BACKGROUND Bone mineral density (BMD) is crucial for evaluating bone health, particularly in the pediatric population. Physical parameters such as lower body strength (assessed by jump tests) and handgrip strength (a marker of musculoskeletal health) have been linked to BMD. This study aims to investigate the association between upper and lower limb strength and BMD of the forearm and femur in children and adolescents stratified by sex. METHODS This cross-sectional study involved 57 participants (aged 9 ± 2 years) from a philanthropic institution in Brazil. Participants were assessed for anthropometric measurements, somatic maturation, and BMD and lean soft tissue using Dual X-ray Absorptiometry (DXA). Handgrip strength was measured using a dynamometer, and horizontal and vertical jump performances were also assessed. Statistical analyses included Quantile Regression to examine the relationships between strength measures and BMD, adjusted for somatic maturation and lean soft tissue. RESULTS Significant positive associations were found between handgrip strength and femoral BMD, especially in boys (Femoral neck: β = 12.65; 95%CI = 2.39; 22.92,; Trochanter: β = 17.37; 95%CI = 5.04; 29.70; Total femur: β = 11.13 95%CI = 0.98; 21.27). CONCLUSION Upper and lower limb muscle strength, particularly handgrip and vertical jump performance, were positively associated with BMD of the forearm and femur in children and adolescents with low socioeconomic status, with associations observed in boys.

Association between 3 D CT-based volumetric fat infiltration of lumbar paraspinal muscles and bone mineral density: a clinical study.

OBJECTIVE This study investigated the association between the fat infiltration rate (FIR) of lumbar paraspinal muscles-specifically the multifidus, erector spinae, and psoas major-and bone mineral density (BMD) in postmenopausal women. By examining muscular and segmental (L2-L4) adiposity variations, we aimed to identify imaging biomarkers for early osteoporosis detection and to inform integrated "bone-muscle" therapeutic strategies. METHODS A retrospective analysis was performed on 120 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) and lumbar computed tomography (CT) between 2024 and 2025. Participants were categorized into three cohorts-normal bone mass, osteopenia, and osteoporosis-based on DXA T-scores. Demographic data, including BMI, were recorded and subsequently utilized as a covariate in the regression models to ensure robust statistical adjustment. The L2-L4 paraspinal musculature was automatically segmented in 3D using 3D Slicer software with the MuscleMap plug-in to determine the FIR for each muscle group. Data normality was assessed using Shapiro-Wilk tests, while inter-group differences were compared via one-way ANOVA or Kruskal-Wallis H tests. Correlations were quantified using Pearson or Spearman analyses. RESULTS Age was comparable across groups ( P = 0. 160 ), but BMI and average BMD differed significantly. Multifidus FIR showed a significant inverse correlation with BMD ( P < 0. 001 ). After adjusting for BMI, multifidus fat infiltration remained an independent predictor of BMD. At the segmental level, the L3 multifidus displayed the greatest inter-group variance and the strongest negative correlation with BMD ( r = -0. 689, P < 0. 001 ). CONCLUSIONS Lumbar paraspinal muscle adiposity, particularly in the L3 multifidus, is inversely associated with BMD in postmenopausal women. Consequently, L3 multifidus FIR is a statistically significant auxiliary imaging metric for proactive osteoporosis screening and the assessment of osteosarcopenia risk.

Visceral adiposity is associated with low trabecular bone score in postmenopausal women with osteopenia.