Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging

• Published in: Osteoporosis international 2023-09, Vol.34 (9), p.1501-1529
• Main Authors: Shevroja, Enisa, Reginster, Jean-Yves, Lamy, Olivier, Al-Daghri, Nasser, Chandran, Manju, Demoux-Baiada, Anne-Laurence, Kohlmeier, Lynn, Lecart, Marie-Paule, Messina, Daniel, Camargos, Bruno Muzzi, Payer, Juraj, Tuzun, Sansin, Veronese, Nicola, Cooper, Cyrus, McCloskey, Eugene V., Harvey, Nicholas C.
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon - methods; Aging; Arthritis; Bone Density; Bone mineral density; Cancellous Bone; Clinical medicine; Consensus; Decision making; Dual energy X-ray absorptiometry; Endocrinology; Epidemiology; Female; Fractures; Humans; Lumbar Vertebrae; Male; Medicine; Medicine & Public Health; Musculoskeletal diseases; Orthopedics; Osteoarthritis; Osteoarthritis - complications; Osteoarthritis - diagnostic imaging; Osteoarthritis - drug therapy; Osteoporosis; Osteoporosis - complications; Osteoporosis - drug therapy; Osteoporotic Fractures - complications; Osteoporotic Fractures - prevention & control; Position Paper; Post-menopause; Predictions; Reviews; Rheumatology; Risk assessment; Risk Assessment - methods; Risk factors; Spine (lumbar); Working groups; World Health Organization
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-023-06817-4

Purpose Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper c