The predictive value of trabecular bone score (TBS) on whole lumbar vertebrae mechanics: an ex vivo study

Osteoporos Int. 2013 Sep;24(9):2455-60. doi: 10.1007/s00198-013-2316-7. Epub 2013 Mar 7.


We investigated the association of trabecular bone score (TBS) with microarchitecture and mechanical behavior of human lumbar vertebrae. We found that TBS reflects vertebral trabecular microarchitecture and is an independent predictor of vertebral mechanics. However, the addition of TBS to areal BMD (aBMD) did not significantly improve prediction of vertebral strength.

Introduction: The trabecular bone score (TBS) is a gray-level measure of texture using a modified experimental variogram which can be extracted from dual-energy X-ray absorptiometry (DXA) images. The current study aimed to confirm whether TBS is associated with trabecular microarchitecture and mechanics of human lumbar vertebrae, and if its combination with BMD improves prediction of fracture risk.

Methods: Lumbar vertebrae (L3) were harvested fresh from 16 donors. The anteroposterior and lateral bone mineral content (BMC) and areal BMD (aBMD) of the vertebral body were measured using DXA; then, the TBS was extracted using TBS iNsight software (Medimaps SA, France). The trabecular bone volume (Tb.BV/tissue volume, TV), trabecular thickness (Tb.Th), degree of anisotropy, and structure model index (SMI) were measured using microcomputed tomography. Quasi-static uniaxial compressive testing was performed on L3 vertebral bodies to assess failure load and stiffness.

Results: The TBS was significantly correlated to Tb.BV/TV and SMI (r = 0.58 and -0.62; p = 0.02, 0.01), but not related to BMC and BMD. TBS was significantly correlated with stiffness (r = 0.64; p = 0.007), independently of bone mass. Using stepwise multiple regression models, we failed to demonstrate that the combination of BMD and TBS was better at explaining mechanical behavior than either variable alone. However, the combination TBS, Tb.Th, and BMC did perform better than each parameter alone, explaining 79% of the variability in stiffness.

Conclusions: In our study, TBS was associated with microarchitecture parameters and with vertebral mechanical behavior, but TBS did not improve prediction of vertebral biomechanical properties in addition to aBMD.

MeSH terms

  • Absorptiometry, Photon / methods
  • Aged
  • Aged, 80 and over
  • Bone Density / physiology
  • Compressive Strength
  • Female
  • Humans
  • Lumbar Vertebrae / anatomy & histology
  • Lumbar Vertebrae / diagnostic imaging*
  • Lumbar Vertebrae / physiology
  • Male
  • Middle Aged
  • Osteoporotic Fractures / etiology
  • Predictive Value of Tests
  • Radiographic Image Interpretation, Computer-Assisted / methods
  • Risk Assessment / methods
  • Spinal Fractures / etiology
  • Stress, Mechanical
  • X-Ray Microtomography / methods