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J Clin Densitom. 2015 Jul-Sep;18(3):309-30. doi: 10.1016/j.jocd.2015.06.008.

Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score.

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Endocrinology Division, Department of Medicine, Santa Casa and Felicio Rocho Hospital, and UNI-BH, Belo Horizonte, Minas Gerais, Brazil. Electronic address:
Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA.
INSERM U1033, University of Lyon, Lyon, France.
Park Nicollet Clinic, HealthPartners, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA.
Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada.


Bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for the diagnosis and management of osteoporosis. However, BMD explains only 60%-80% of bone strength, and a number of skeletal features other than BMD contribute to bone strength and fracture risk. Advanced imaging modalities can assess some of these skeletal features, but compared to standard DXA, these techniques have higher costs and limited accessibility. A major challenge, therefore, has been to incorporate in clinical practice a readily available, noninvasive technology that permits improvement in fracture-risk prediction beyond that provided by the combination of standard DXA measurements and clinical risk factors. To this end, trabecular bone score (TBS), a gray-level textural index derived from the lumbar spine DXA image, has been investigated. The purpose of this International Society for Clinical Densitometry task force was to review the evidence and develop recommendations on how to incorporate TBS in clinical practice. Clinical applications of TBS for fracture risk assessment, treatment initiation, monitoring of treatment, and use of TBS in special conditions related to greater fracture risk, were addressed. We present the official positions approved by an expert panel following careful review of the recommendations and evidence presented by the TBS task force.


Dual energy X-ray absorptiometry; FRAX; fracture risk; official positions; trabecular bone score

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