It is indicated that trabecular microarchitecture deteriorates earlier and more rapidly with aging than bone mass loss captured by BMD, supporting the use of TBS as a complementary tool for evaluating skeletal health and fracture risk.
Abstract
Objective
To evaluate age-related changes in lumbar spine trabecular bone microarchitecture using the trabecular bone score (TBS) and to establish age-specific reference values for healthy Brazilian women.
Methods
In this cross-sectional study, we evaluated 527 healthy adult women aged 20-82 years recruited as a convenience sample from hospital employees and their relatives. Lumbar spine TBS and bone mineral density (BMD) were obtained from a Hologic Discovery A DXA system using TBS iNsight software (v3.0.3). Primary analyses were restricted to BMI 15-37 kg/m2 and excluded current menopausal hormone therapy users, with sensitivity analyses including these participants. Women were stratified by age decade; menopause-centered analyses were additionally performed using years since menopause, and nonlinearity was explored using restricted cubic splines.
Results
In the primary analytical sample (n=477), TBS was independently associated with age after adjustment for height and weight (β=-0.004 per year, P<0.001). Among postmenopausal women, years since menopause was independently associated with lower TBS (β=-0.002 per year, P=0.010). Menopausal status and the age-by-menopausal status interaction were not independently associated with TBS. TBS declined earlier across age decades than BMD T-scores, and sensitivity analyses including hormone therapy users yielded similar results. Using the reference distribution from premenopausal women aged 20-39 years, TBS cutoffs were 1.365 for normal microarchitecture and 1.248 for degraded microarchitecture, with intermediate values indicating partially degraded microarchitecture. A substantial proportion of women with normal BMD showed impaired trabecular microarchitecture by TBS, ranging from 34.8% to 41.6% across skeletal sites.
Conclusions
This study provides the first age-specific normative TBS reference data for Brazilian women. The findings indicate that trabecular microarchitecture deteriorates earlier and more rapidly with aging than bone mass loss captured by BMD, supporting the use of TBS as a complementary tool for evaluating skeletal health and fracture risk.
In postmenopausal women, higher BMI was associated with higher BMD but lower TBS, supporting a divergent relationship between densitometric findings and DXA-derived trabecular texture parameters, and suggesting that TBS may complement BMD in describing skeletal imaging status in overweight and obese women.
Objective To develop and validate a clinical prediction model integrating lumbar spine bone mineral density (LS-BMD) and fall risk assessment for identifying secondary osteoporosis in community-dwelling elderly men. Methods This retrospective cross-sectional study enrolled men aged 65 years or older from community health centers and geriatric outpatient clinics (June 2023-December 2025). Secondary osteoporosis was defined as T-score ≤ −2.5 at any site (lumbar spine, femoral neck, or total hip) with at least one confirmed major secondary etiology (hypogonadism, glucocorticoid use, vitamin D deficiency, etc). Controls were men with normal BMD or osteopenia without secondary etiology. Participants were randomly assigned to training (70%) and validation (30%) sets. LASSO regression and multivariate logistic regression were used for variable selection and model construction. Bootstrap resampling provided optimism-corrected performance estimates. Results Among 843 eligible participants (mean age 73.12±5.27 years), 187 (22.18%) were diagnosed with secondary osteoporosis. Six independent predictors were identified: age, LS-BMD T-score, history of fall, testosterone, glucocorticoid use, and vitamin D level. The apparent AUC was 0.846 (95% CI: 0.815–0.878) in the training set and 0.798 (95% CI: 0.741–0.854) in the validation set; the optimism-corrected AUC was 0.731, indicating moderate discrimination. Calibration was satisfactory. Decision curve analysis confirmed clinical net benefit. Of note, three predictors (testosterone, vitamin D, glucocorticoid use) overlap with the diagnostic criteria for secondary osteoporosis, and the AUC values should be interpreted with this caveat in mind. Conclusion This study developed a preliminary clinical prediction model for identifying secondary osteoporosis in elderly men using internal validation. The model integrates LS-BMD T-score, fall risk, Vitamin D, testosterone, and glucocorticoid use, but external validation is required before clinical application. The overlap between several predictors and the diagnostic criteria represents an important limitation.
Yi-You Fang, Liang Zhang, Gang Dong et al.· Orthopedic Research and Revi...· 0 citations
Upper and lower limb muscle strength, particularly handgrip and vertical jump performance, were positively associated with BMD of the forearm and femur in children and adolescents with low socioeconomic status, with associations observed in boys.
S. C. Silva, B. Saraiva, E. D. L. Mesquita et al.· BMC Pediatrics· 0 citations
The trabecular bone score (TBS) provides complementary, indirect information on trabecular microarchitecture that may be independently impaired in SSc, and SSc patients exhibit significantly impaired bone microarchitecture compared with matched controls.
Nipaporn Intarasattakul, C. Pongchaiyakul, C. Foocharoen et al.· Journal of clinical densitom...· 0 citations
Background:To analyze the bone mineral density (BMD) status of postmenopausal women, thereby providing a basis for precise clinical nursing interventions, an area that remains underexplored in tailored gerontological nursing practice.Methods:This was a retrospective and cross-sectional study. A total of 1375 postmenopausal women aged 45–59 years who underwent BMD examination at Jinhua Hospital of Zhejiang University from January 1, 2025, to December 31, 2025 were retrospectively enrolled. Demographic data, bone metabolism markers, sex hormones, blood lipids, and other relevant indices were collected. Participants were categorized into three groups based on BMD results: normal BMD, osteopenia, and osteoporosis. Intergroup comparisons were performed using the Kruskal-Wallis test, one-way analysis of variance (ANOVA), or the χ2 test. Independent associated factors were identified using multinomial logistic regression, and subgroup analyses were performed.Results:Subgroup analysis revealed that BMD decreased with increasing age (p < 0.001) and decreasing body mass index (BMI) (p < 0.001), and that BMD distribution also differed among occupational types (p = 0.001). Compared with the normal BMD group, univariate analysis and multinomial logistic regression showed that older age, lower BMI, lower serum calcium, and elevated alkaline phosphatase (ALP) were independently associated with osteopenia (p < 0.05 for all). Estradiol levels also showed a statistically significant but clinically negligible association (p = 0.035). Older age, lower BMI, elevated ALP, lower testosterone, and elevated lipoprotein(a) levels were identified as independent predictors for osteoporosis (p < 0.05 for all).Conclusions:Increasing age, low BMI, increased bone turnover, reduced testosterone, and elevated lipoprotein(a) were identified as factors significantly associated with reduced BMD in postmenopausal women.
Xiaochang Ye, Sisi Wang, Yongan Hu et al.· Clinical and Experimental Ob...· 0 citations
It is suggested that visceral adiposity measured by opportunistic CT may serve as a potential biomarker for identifying postmenopausal women with osteopenia who are at an increased risk of fracture.
Tae Ran Ahn, Hyun Su Kim, D. Cha et al.· Skeletal Radiology· 0 citations