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Summary: We found that lumbar spine texture analysis using trabecular bone score ( TBS ) is a risk factor for MOF and a risk factor for death in a retrospective cohort study from a large clinical registry for the province of Manitoba, Canada. Introduction: FRAX® estimates the 10-year probability of major osteoporotic fracture ( MOF ) using clinical risk factors and femoral neck bone mineral density ( BMD ). Trabecular bone score ( TBS ), derived from texture in the spine dual X-ray absorptiometry ( DXA ) image, is related to bone microarchitecture and fracture risk independently of BMD. Our objective was to determine whether TBS provides information on MOF probability beyond that provided by the FRAX variables. Methods: We included 33,352 women aged 40–100 years ( mean 63 years ) with baseline DXA measurements of lumbar spine TBS and femoral neck BMD. The association between TBS, the FRAX variables, and the risk of MOF or death was examined using an extension of the Poisson regression model. Results: During the mean of 4.7 years, 1,754 women died and 1,872 sustained one or more MOF. For each standard deviation reduction in TBS, there was a 36 % increase in MOF risk ( HR 1.36, 95 % CI 1.30–1.42, p  <  0.001 ) and a 32 % increase in death ( HR 1.32, 95 % CI 1.26–1.39, p  <  0.001 ). When adjusted for significant clinical risk factors and femoral neck BMD, lumbar spine TBS was still a significant predictor of MOF ( HR 1.18, 95 % CI 1.12–1.23 ) and death ( HR 1.20, 95 % CI 1.14–1.26 ). Models for estimating MOF probability, accounting for competing mortality, showed that low TBS ( 10th percentile ) increased risk by 1.5–1.6-fold compared with high TBS ( 90th percentile ) across a broad range of ages and femoral neck T-scores. Conclusions: Lumbar spine TBS is able to predict incident MOF independent of FRAX clinical risk factors and femoral neck BMD even after accounting for the increased death hazard.


Institute for Health and Ageing

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