[{"@context":"https:\/\/schema.org\/","@type":"Article","@id":"https:\/\/betterbones.com\/testing\/trabecular-bone-score-and-the-quest-to-predict-who-will-fracture\/#Article","mainEntityOfPage":"https:\/\/betterbones.com\/testing\/trabecular-bone-score-and-the-quest-to-predict-who-will-fracture\/","headline":"Trabecular Bone Score and the Quest to Predict Who Will Fracture","name":"Trabecular Bone Score and the Quest to Predict Who Will Fracture","description":"Print PDF eBook Facebook Twitter Gmail LinkedIn Pinterest 7 Each year 178 million new osteoporotic fractures occur worldwide. These fractures are painful, costly, and at times life-limiting. In the hope of preventing these fractures, medical systems around the world have looked for ways to identify those at greatest fracture risk. In Traditional Chinese Medicine the […]","datePublished":"2023-12-09","dateModified":"2026-04-22","author":{"@type":"Person","@id":"https:\/\/betterbones.com\/author\/brownbetterbonesgmail-com\/#Person","name":"Dr. Susan E. Brown, PhD","url":"https:\/\/betterbones.com\/author\/brownbetterbonesgmail-com\/","identifier":72,"image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/8e08d87bd45250c6616e1752933a6576aba077f335d97ee337a0cde5e435cbd3?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/8e08d87bd45250c6616e1752933a6576aba077f335d97ee337a0cde5e435cbd3?s=96&d=mm&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"Center for Better Bones","logo":{"@type":"ImageObject","@id":"https:\/\/betterbones.com\/wp-content\/uploads\/2018\/12\/Better-Bones-AMP.png","url":"https:\/\/betterbones.com\/wp-content\/uploads\/2018\/12\/Better-Bones-AMP.png","width":150,"height":60}},"image":{"@type":"ImageObject","@id":"https:\/\/betterbones.com\/wp-content\/uploads\/2023\/12\/Trabecular-Bone-Score-blog-Header.jpeg","url":"https:\/\/betterbones.com\/wp-content\/uploads\/2023\/12\/Trabecular-Bone-Score-blog-Header.jpeg","height":1109,"width":2120},"url":"https:\/\/betterbones.com\/testing\/trabecular-bone-score-and-the-quest-to-predict-who-will-fracture\/","video":{"@context":"http:\/\/schema.org\/","@type":"VideoObject","@id":"https:\/\/www.youtube.com\/watch?v=dezFR7ET0o4#VideoObject","contentUrl":"https:\/\/www.youtube.com\/watch?v=dezFR7ET0o4","name":"NEW Bone STRENGTH and QUALITY Testing with Trabecular Bone Score","description":"Learn more on the groundbreaking advancements in bone health\nwith the benefits of Trabecular Bone Score (TBS), offering a 30% increase in bone information compared to conventional DEXA scans! \n\nDr. Susan Brown sits down with one of the main disruptors in the whole field of natural bone health \u2014 Johnny Harper, who leads Body Analytics Fitness Center in St. Louis, about his augmented DEXA machine that looks not only at bone density, but gathers information at bone quality and strength! See how he has worked to correct the errors that 90% of DEXA scans bring. \n\nLearn more about Johnny's work here: https:\/\/bodyanalytics.fit\/\nand Dr. Susan Brown: www.betterbones.com\n\n\n\u2192 Interested in a product Dr. Brown talked about in one of her videos? Learn more about Dr. Brown's professional-grade nutrients at - https:\/\/alkalineforlife.com\n\n\u2192 Want to learn everything you need to manage & reverse your osteoporosis\/osteopenia naturally in one comprehensive ONLINE MASTERCLASS with Dr. Brown? Join Dr. Brown's Better Bones Solution (Rave Reviews \ud83c\udf1f\ud83c\udf1f\ud83c\udf1f\ud83c\udf1f\ud83c\udf1f)! Learn more and sign up for this Masterclass here: https:\/\/tribe.drsusanbrownphd.com\/plans\/242004?bundle_token=f02b7ca12e192a0257d465338d133e02&utm_source=manual\n\n\u2192 If you are interested in working with Dr. Brown to develop a personalized natural bone health program, read more about consultations here: https:\/\/www.betterbones.com\/consultations\/help-osteoporosis-osteopenia-fracture-healing-bone-health-concerns\/\n\n\u2192 Questions for Dr. Brown?  Comment below and she may address them in a future video! If you want your questions answered right away by Dr. Brown herself, you can sign up for her Office Hours, where she will answer questions on Zoom in a group format once a week. Sign up for the next session here: https:\/\/shop.betterbones.com\/collections\/education\/products\/office-hours-w-dr-brown\n\nCheck out our website! \u2192 http:\/\/ www.betterbones.com\n\nWant to connect with Better Bones on social media?\nSubscribe on TikTok \u2192 https:\/\/www.tiktok.com\/@drsusanbrown\nLike on Facebook \u2192 http:\/\/www.facebook.com\/betterbonesbetterbody\n\u200bFollow on Twitter \u2192 http:\/\/www.twitter.com\/drsusanbrown\n\u200bFollow our Instagram \u2192 http:\/\/www.instagram.com\/drsusanbrown\n\u200bCheck out our Pinterest \u2192 http:\/\/www.pinterest.com\/betterbonesbetterbody\n\n#drsusanbrown #johnnyharper #bodyanalytics #osteoporosis #osteoporosisprevention #osteopenia #holistichealth #bonehealth #bonedensity #bonedensitytest #DEXA #dexascan #TBS #trabecularbonescore","thumbnailUrl":["https:\/\/i.ytimg.com\/vi\/dezFR7ET0o4\/default.jpg","https:\/\/i.ytimg.com\/vi\/dezFR7ET0o4\/mqdefault.jpg","https:\/\/i.ytimg.com\/vi\/dezFR7ET0o4\/hqdefault.jpg","https:\/\/i.ytimg.com\/vi\/dezFR7ET0o4\/sddefault.jpg","https:\/\/i.ytimg.com\/vi\/dezFR7ET0o4\/maxresdefault.jpg"],"uploadDate":"2023-12-12T02:22:46+00:00","duration":"PT4M53S","embedUrl":"https:\/\/www.youtube.com\/embed\/dezFR7ET0o4","publisher":{"@type":"Organization","@id":"https:\/\/www.youtube.com\/channel\/UCm6Zry9uGdrZpm05sQLIxMw#Organization","url":"https:\/\/www.youtube.com\/channel\/UCm6Zry9uGdrZpm05sQLIxMw","name":"Dr. Susan E. Brown","description":"Dr. Susan E. Brown, PhD, is a medical anthropologist, a New York State Certified Nutritionist, and the author of Better Bones, Better Body -- the first comprehensive look at natural bone health. Dr. Brown specializes in osteoporosis, osteopenia, bone health regeneration, and auto-immune disease. She is also famous for her natural approach to bone health; check out her Better Bones programs and products.","logo":{"url":"https:\/\/yt3.ggpht.com\/ytc\/AIdro_m0l08uY9k8RO1FbN8-VsYIOa8fiq9BtocNNM_k3xw7a7s=s800-c-k-c0x00ffffff-no-rj","width":800,"height":800,"@type":"ImageObject","@id":"https:\/\/www.youtube.com\/watch?v=dezFR7ET0o4#VideoObject_publisher_logo_ImageObject"}},"potentialAction":{"@type":"SeekToAction","@id":"https:\/\/www.youtube.com\/watch?v=dezFR7ET0o4#VideoObject_potentialAction","target":"https:\/\/www.youtube.com\/watch?v=dezFR7ET0o4&t={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"},"interactionStatistic":[[{"@type":"InteractionCounter","@id":"https:\/\/www.youtube.com\/watch?v=dezFR7ET0o4#VideoObject_interactionStatistic_WatchAction","interactionType":{"@type":"WatchAction"},"userInteractionCount":3370}],{"@type":"InteractionCounter","@id":"https:\/\/www.youtube.com\/watch?v=dezFR7ET0o4#VideoObject_interactionStatistic_LikeAction","interactionType":{"@type":"LikeAction"},"userInteractionCount":102}]},"about":["Testing"],"wordCount":1305,"articleBody":" Print PDF eBook\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tFacebook\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTwitter\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tGmail\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tLinkedIn\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tPinterest\t\t\t\t\t\t7\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tEach year 178 million new osteoporotic fractures occur worldwide. These fractures are painful, costly, and at times life-limiting. In the hope of preventing these fractures, medical systems around the world have looked for ways to identify those at greatest fracture risk. In Traditional Chinese Medicine the kidney energy meridian system is evaluated, as this is held to largely dictate bone health. In the 5,000-year-old Ayurveda Health Science of India those with an imbalance of the Air and Ether elements (known as Vata dosha) carry an increased fracture risk.Westernized countries have taken the route of X-ray technology to both predict who will fracture and define osteoporosis. You may have heard of the Trabecular Bone Score (TBS), the \u201cnew kid on the block\u201d of X-ray fracture risk assessment. Let\u2019s begin by putting TBS in its proper historical context.Table of ContentsToggle     6 Minutes ReadThe U.S. Fracture Prediction Quest Timeline: Where TBS Fits InTrabecular Bone Score (TBS): What It IsThe U.S. Fracture Prediction Quest Timeline: Where TBS Fits In1985, Harvard University, firsthand account, as I was thereIn 1985, a small group of bone researchers met at Harvard University to announce their groundbreaking development of advanced X-ray technology that could measure bone density. I attended this meeting and sensed an air of excitement and optimism as we were told that science would now be able to predict who would fracture using this bone density measurement machine. This was the birth of the DEXA bone density device still being used today.1985 to 1994These new bone density testing machines were put into service and hundreds of thousands of women, and selected men, received bone density testing. Data from these 10 years were analyzed over time.1994, Geneva, Switzerland A handful of doctors met in Geneva, Switzerland in 1994 under the auspices of the World Health Organization. Using the 10 years of bone density testing data, they developed both a new definition of osteoporosis, and a new way to predict fracture. By their action osteoporosis was now to be defined by bone density T-Scores. As a result of these decisions, you are now told you have \u201costeoporosis\u201d if your T-score is -2.5 or higher.As data on the correlation between bone density T-score and fracture risk were analyzed over the next 20 years, the inability of bone density testing to predict fracture was becoming obvious.2008, UKResearchers introduced the FRAX (Facture Risk Assessment Tool) as an adjunct to the bone density testing to improve fracture prediction. The FRAX questionnaire consists of 11 known clinical risk factors for osteoporosis (age, sex, weight, height, previous fracture, parent fractured hip, current smoking, glucocorticoids steroid medications, rheumatoid arthritis, known secondary osteoporosis, and alcohol intake). The hope was that the addition of this FRAX questionnaire would enhance the fracture predictability of the DEXA bone density results. Success was limited as there are more than 100 risk factors for osteoporosis. 2014 and beyondExtensive analysis of the correlation between bone density scores and fracture incidence revealed that the likelihood of fracture could not be predicted effectively through DEXA bone density. Up to 80% of all osteoporotic fractures were shown to occur in those who did not have an osteoporotic T-score of -2.5 or greater. Further, many of those with an osteoporotic T-score did not fracture. 2015, The Trabecular Bone ScoreIn 2015 the International Society for Clinical Densitometry published its first official position on the Trabecular Bone Score (TBS). The TBS then became used as an adjunct to DEXA bone density testing. Again, the hope was to improve the fracture prediction capacity of DEXA bone density testing. Trabecular Bone Score (TBS): What It IsAt the Center for Better Bones, we see the trabecular bone score as an interesting attempt to rectify some of the shortcomings of DEXA bone mineral density. Specifically, DEXA bone density testing does not reveal real bone strength, and bone strength is most likely what predicts fracture.The TBS is a parameter that attempts to capture bone strength by assessing the microarchitecture of lumbar (lower spine) trabecular bone (internal spongy bone). This is done by amplification and analysis of the radiographic image from the bone density testing machine. The goal is to discern differences on 3-dimensional microarchitecture between 2- dimensional DEXA measurements that present with similar bone mineral density.To date several researchers have suggested that a higher TBS value is associated with a better and more fracture-resistant bone microarchitecture. A lower TBS value, they report, is associated with weaker, more fracture-prone bone microarchitecture.\u00a0 \u00a0 \u00a0 \u00a0 \u00a0  Determining who will fracture, however, is a complicated endeavor and not all research on TBS supports its value for fracture prediction. For example, one study suggested a significant TBS fracture predictive value for Caucasian American women, but not for African Americans or Mexican Americans. Overall, it will take many more years of study to reveal the true fracture predictive value of the TBS.Nonetheless, at the Center for Better Bones we feel that for some the TBS might be a worthwhile adjunct to the current DEXA bone density test. However, this test is not widely available. Currently few DEXA bone testing devices have the software necessary to produce the Trabecular Bone Score and it may be difficult to find one in your area.To find a bone testing device that can also give you a TBS\u00a0 score, you can ask at the office where you get your DEXA test. We have been lucky enough to find a quality technician at Body Analytics in St. Louis, MO.\u00a0 Watch this short video with Dr. Brown and our colleague Johnny Harper from Body Analytics to learn more about why this test might benefit you and why you should seek out an experienced technician! ReferencesCundy, T., et al. 1995. Sources of interracial variation in bone mineral density. Journal of Bone and Mineral Research 10(3):368-373.Garg, M. K. and S. Kharb. 2013. Dual-energy X-ray absorptiometry: Pitfalls in measurement and interpretation of bone mineral density. Indian Journal of Endocrinology and Metabolism 17(2):203-210.Jain, R. K. and T. Vokes. 2018. Association of trabecular bone score (TBS) and prior fracture differs among minorities in NHANES 2005-2008. Osteoporosis International 29(9):2093-2099.J\u00e4rvinen, T. L. N., et al. 2015. Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ 350:h2088.Lekamwasam, S., et al. 2020. Ability of FRAX Sri Lanka adjusted for trabecular bone score to discriminate between postmenopausal women with a recent fracture and without a fracture. Osteoporosis and Sarcopenia 6(3):106-110.Mayo Clinic. 2015. New tools to predict fracture risk. Mayo Clinic website, Medical Professional, Endocrinology. Last accessed 12-5-23.Ott, S. 2023. Osteoporosis and bone physiology. Dr. Susan Ott\u2019s website: View University of Washington bone health resourcePalomo, T., et al. 2022. Update on trabecular bone score. Archives of Endocrinology and Metabolism 66(5):694-706.Rajan, R., et al. 2020. Trabecular bone score\u2014An emerging tool in the management of osteoporosis. Indian Journal of Endocrinology and Metabolism 24(3):237-243.Seeman, E., et al. 2008. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. Journal of Bone and Mineral Research 23(3):433-438.Shevroja, E., et al. 2017. Use of trabecular bone score (TBS) as a complementary approach to dual-energy X-ray absorptiometry (DXA) for fracture risk assessment in clinical practice. Journal of Clinical Densitometry 20(3):334-345.Siris, E. S., et al. 2001. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: Results from the National Osteoporosis Risk Assessment. JAMA 286(22):2815-2822.Stone, K. L., et al. 2003. BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures. Journal of Bone and Mineral Research 18(11):1947-1954.Wainwright, S. A., et al. 2005. Hip fracture in women without osteoporosis. Journal of Clinical Endocrinology and Metabolism 90(5):2787-2793.WHO (World Health Organization). 1994. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Report of a WHO study group. WHO Technical Report Series 843. WHO, Geneva."},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Testing","item":"https:\/\/betterbones.com\/testing\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"Trabecular Bone Score and the Quest to Predict Who Will Fracture","item":"https:\/\/betterbones.com\/testing\/trabecular-bone-score-and-the-quest-to-predict-who-will-fracture\/#breadcrumbitem"}]}]