Evaluation of Bone Mineral Density and Trabecular Bone Score as Predictors of Vertebral Compression Fracture Severity: A Cross-sectional Study

Abstract

Background: Bone mineral density (BMD) is central to osteoporosis assessment, but it may not fully reflect skeletal fragility. Trabecular bone score (TBS) may provide complementary information regarding vertebral fracture severity. Methods: This hospital-based cross-sectional study included 90 adults with vertebral compression fractures evaluated by dual-energy X-ray absorptiometry and lumbar TBS. Vertebral fractures were graded using the Genant semiquantitative classification, and cumulative fracture burden was assessed using the Spinal Deformity Index (SDI). Associations of BMD and TBS with fracture severity were examined using group comparisons, correlation, logistic regression, and receiver operating characteristic analysis. Results: Lumbar spine, femoral neck, and total hip BMD declined with increasing Genant grade. TBS also decreased progressively across grades and was inversely correlated with SDI. Degraded TBS was more frequent in Grade 3 fractures. In adjusted analysis, lower TBS remained associated with severe vertebral fracture after inclusion of age and lumbar BMD. Adding TBS increased model AUC from 0.680 to 0.734. Conclusion: TBS complements BMD in characterizing vertebral compression fracture severity and may improve assessment of skeletal fragility.