New technology is helping health care providers decide how likely it is that a patient will break a bone. Trabecular Bone Score (TBS) is software that analyzes the internal structure of the spine bones to give a more complete picture of how strong they are. Health care providers commonly diagnose osteoporosis using a DXA scan to test bone mineral density. TBS provides more information that can improve how health care providers diagnose and treat patients. Whether or not you already have had a DXA, keep reading — you will want to know how additional tools can help you avoid life-changing fractures.
DXA is the best way to test bone mineral density.
When it comes to testing for osteoporosis and your risk of broken bones, the gold standard is dual X-ray absorptiometry, or DXA. This test checks the bone mineral density at a few places on your body and gives you a “T-score.” The T-score compares your bones to those of a healthy 30-year-old.
- If your T-score is -1 or higher, your bone density is normal (higher than +1 indicates that your bones are even stronger than the average 30-year-old).
- If your T-score is between -1 and -2.5, you have low bone density, or osteopenia.
- If your T-score is -2.5 or lower, you have osteoporosis.
Bone quantity is different from bone quality.
Your T-score measures your bone mass or bone quantity; however, that does not tell the whole story.
Think about your heart. A high total cholesterol is one factor that can increase your risk of a heart attack, but it’s not the only factor. Two patients could have the same total cholesterol of 250 mg/dL:
- Patient A could be normal weight and healthy, have a good cholesterol (HDL) value of 120 and bad cholesterol (LDL) value of 110 and have very low risk of heart disease.
- Patient B could be obese, have diabetes and high blood pressure, HDL value of 35 and LDL value of 195 and have very high risk of heart disease.
A T-score by itself is like total cholesterol value. TBS, by assessing bone quality, improves the diagnosis of fracture risk – just like knowing your HDL and LDL numbers adds value to the diagnosis of high cholesterol and risk of heart disease.
Of the people who have a broken spine bone or hip, only 33% have a T-score in the osteoporosis range (-2.5 or lower). There are many factors in addition to low bone density that can put you at risk of a fracture, or “bone attack.” Here are a few:
- Medical conditions like diabetes, rheumatoid arthritis and other auto-immune inflammatory diseases, cancer, Parkinson’s disease, or chronic kidney disease.
- Medicines like corticosteroids that treat arthritis, Crohn’s disease, or lupus.
- Smoking or vaping.
- Having more than two alcoholic drinks a day.
- A sedentary lifestyle, or long periods of bedrest.
These factors affect your bone quality.
Bone quality is important to understanding your risk of breaking a bone. Knowing your bone quality means you can talk to your health care provider about making a bone health plan. Your health care provider can give you steps to take to strengthen your bones, including starting a medicine if necessary.
On the other hand, there are patients who might have low bone density but aren’t at high risk of breaking a bone. This includes people who are petite or thin. That is because a DXA measures bone density based on a two-dimensional image.
Bone Health & Osteoporosis Foundation Fracture Risk Calculator™ (developed by American Bone Health) helps identify other factors besides bone density
Once you have a T-score from a DXA test, you can get a better idea of your fracture risk by answering a list of questions about your age, weight, family history, smoking, medical conditions and medications, etc.
American Bone Health designed its Fracture Risk Calculator for use in the United States. Health care providers can use the results of this assessment to help diagnose your risk of breaking a bone in the next 10 years.
Trabecular Bone Score can improve prediction of broken bones.
Measuring your TBS is a newer method that fine-tunes a DXA scan. Health care providers say it helps them diagnose fracture risk and discuss treatment options with patients.
TBS software is added to DXA machines. The TBS software analyzes DXA images of the spine bones to determine bone texture, which reflects the bone structure or “microarchitecture.” When the spongy inner part of the bones becomes thinner due to age and other factors, your bones are at higher risk of breaking.
TBS is a separate risk factor from your bone density. Because TBS measures bone quality, research suggests it adds to DXA in predicting patients whose bones are at risk of breaking due to diseases or medicines they are taking. Two patients could have the same bone density T-score but different bone structure and a different risk of breaking a bone. TBS helps health care providers and patients figure out the benefit of treatment with a medicine.
Adapted from Hans et al. J Bone Miner Res. 2011, courtesy of Medimaps
* Results derived from Manitoba study data; presented. By D Hans at the2ndArgentinianCongressofOsteology, Oct.2018.
A study conducted in the Canadian province of Manitoba (Hans et al. J Bone Miner Res. 2011) tested whether TBS can help predict major osteoporotic fractures (MOF) of the hip, spine, upper arm, and wrist, better than DXA alone. Researchers analyzed DXA results from 29,407 women age 40 and older for both bone mineral density and TBS. BMD and TBS combined did a better job of predicting the women who would have a major broken bone than either BMD or TBS alone. TBS data also showed that women who have low TBS plus BMD in the osteopenia range (T-score of -1 to -2.5) had five times higher risk of a major broken bone than women with normal BMD plus normal TBS.
What you need to know about Trabecular Bone Score
TBS is registered by the FDA for clinical use in the U.S. More than 450 testing centers in the United States offer TBS along with DXA scans. If you have already had a DXA scan and would like to follow up with TBS, manufacturers recommend you go to the same testing center for another scan.
Most health insurance plans cover a DXA scan every two years for women 65 and older and men 70 and older, but patients currently must pay for TBS. Costs depend on the practice, as little as $25 or as much as $150. Some physician societies are asking Medicare to cover TBS because of its added benefit.
Other new technologies for diagnosing fracture risk
Several companies are using artificial intelligence (AI) to help physicians identify patients who need osteoporosis treatment. AI uses automation to look at X-ray and other medical records to find patients at elevated fracture risk. The goal is to get these patients the treatment they need and enroll them in bone care management programs. This technology is not registered for clinical use in the U.S.
Another emerging technology is radiofrequency echographic multi spectrometry, or R.E.M.S. This is a type of ultrasound that can check both bone density and bone quality. This technology is not registered for clinical use in the U.S.
Ask your health care provider if any of these tools could help predict your personal risk of breaking a bone.
Fracture risk depends on more than just a T-score
Remember that your fracture risk depends on many factors, not just your T-score from a bone density test. Lifestyle, medicines you take, how often you fall, and other medical conditions – all affect your risk of breaking a bone. New technologies are helping health care providers focus on what is important: assessing a patient’s fracture risk to prevent broken bones.
Posted: 09/28/2020.
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