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Original Research

Open Access

Associations between trabecular bone score and bone mineral density in Taiwanese older adult men

  • Mei-Lan Huang1,2
  • Tsyh-Jyi Hsieh1,3,*,
  • Song-Shei Lin2,*,
  • Wen-Chuan Huang4

1Department of Medical Imaging, Chi Mei Medical Center, 710 Tainan, Taiwan

2Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, 40601 Taichung, Taiwan

3Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 807 Kaohsiung, Taiwan

4School of Continuing Education, Fu Jen Catholic University, 242 Taipei, Taiwan

DOI: 10.22514/jomh.2023.005 Vol.19,Issue 1,January 2023 pp.15-22

Submitted: 04 August 2022 Accepted: 21 September 2022

Published: 30 January 2023

*Corresponding Author(s): Tsyh-Jyi Hsieh E-mail:
*Corresponding Author(s): Song-Shei Lin E-mail:


Osteoporosis is a common bone disease in older adults, and it is a predictor of bone fracture. This study determined the mean trabecular bone score (TBS) of older Taiwanese men in different age groups and analyzed the effectiveness of TBS in predicting osteoporosis risk. A total of 1568 men aged 50 and older were enrolled. The demographic characteristics; bone mineral density (BMD) T-scores of the spine, total hip, and femoral neck; and TBS of the spine were recorded to statistically determine osteoporosis-related factors. The average age (range) of the included patients was 59.5± 7.5 (50.0–92.7) years. The mean (range) TBS was 1.386 ± 0.073 (0.999–1.605). The TBS was moderately and positively correlated with the BMD T-scores of the spine, total hip, and femoral neck (r = 0.516, 0.499, and 0.480, respectively). The lowest of the BMD T-scores measured at multiple sites revealed a higher rate of osteoporosis (5.5%) than did BMD T-scores measured at individual sites. Moreover, bone microarchitecture degradation was noted in 2.2% of the patients. Compared with the use of BMD alone, a combination of BMD and TBS predicted more patients (1.4%) to be at a high risk of osteoporosis. Combining the lowest BMD and TBS revealed that 20.3% of patients aged ≥70 years had a high risk of osteoporosis. TBS can be used to clinically assess the risk of osteoporosis in older adults without osteoporosis. We recommend combining the lowest BMD T-score and TBS for predicting the risk of osteoporosis.


Trabecular bone score; Bone mineral density; Osteoporosis; DXA; Older men

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Mei-Lan Huang,Tsyh-Jyi Hsieh,Song-Shei Lin,Wen-Chuan Huang. Associations between trabecular bone score and bone mineral density in Taiwanese older adult men. Journal of Men's Health. 2023. 19(1);15-22.


[1] He W, Goodkind D, Kowal PR. An aging world: 2015. United States Census Bureau: Washington, DC, USA. 2016.

[2] Lin YY, Huang CS. Aging in Taiwan: building a society for active aging and aging in place. The Gerontologist. 2016; 56: 176–183.

[3] WHO Scientific Group on Prevention, Management of Osteoporosis, World Health Organization. Prevention and management of osteoporosis: report of A WHO scientific group. World Health Organization: Switzer-land. 2003.

[4] Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C; IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International. 2012; 23: 2239–2256.

[5] Wu CH, McCloskey EV, Lee JK, Itabashi A, Prince R, Yu W, et al. Consensus of official position of IOF/ISCD FRAX initiatives in Asia-Pacific region. Journal of Clinical Densitometry. 2014; 17: 150–155.

[6] Yang N, Deng C, Chou Y, Chen P, Lin C, Chou P, et al. Estimated prevalence of osteoporosis from a Nationwide Health Insurance database in Taiwan. Health Policy. 2006; 75: 329–337.

[7] Lin YC, Pan WH. Bone mineral density in adults in Taiwan: results of the Nutrition and Health Survey in Taiwan 2005–2008 (NAHSIT 2005–2008). Asia Pacific Journal of Clinical Nutrition. 2011; 20: 283–291.

[8] Peck WA. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. The American Journal of Medicine. 1993; 94: 646–650.

[9] Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996; 312: 1254–1259.

[10] World Health Organization. WHO scientific group on the assessment of osteoporosis at primary health care level. Summary Meeting Report. 2004; 5: 5–7.

[11] Lewiecki EM, Kendler DL, Kiebzak GM, Schmeer P, Prince RL, El-Hajj Fuleihan G, et al. Special report on the official positions of the international society for clinical densitometry. Osteoporosis International. 2004; 15: 779–784.

[12] Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004; 34: 195–202.

[13] Hans D, Goertzen AL, Krieg M, Leslie WD. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the manitoba study. Journal of Bone and Mineral Research. 2011; 26: 2762–2769.

[14] Carbonare LD, Giannini S. Bone microarchitecture as an important determinant of bone strength. Journal of Endocrinological Investigation. 2004; 27: 99–105.

[15] Rubin CD. Emerging concepts in osteoporosis and bone strength. Current Medical Research and Opinion. 2005; 21: 1049–1056.

[16] Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. Journal of Bone and Mineral Research. 2014; 29: 518–530.

[17] Del Rio LM, Winzenrieth R, Cormier C, Di Gregorio S. Is bone microarchitecture status of the lumbar spine assessed by TBS related to femoral neck fracture? A Spanish case-control study. Osteoporosis International. 2013; 24: 991–998.

[18] Iki M, Tamaki J, Kadowaki E, Sato Y, Dongmei N, Winzenrieth R, et al. Trabecular bone score (TBS) predicts vertebral fractures in Japanese women over 10 years independently of bone density and prevalent vertebral deformity: the Japanese population-based osteoporosis (JPOS) cohort study. Journal of Bone and Mineral Research. 2014; 29: 399–407.

[19] Leib E, Winzenrieth R, Aubry-Rozier B, Hans D. Vertebral microarchi-tecture and fragility fracture in men: a TBS study. Bone. 2014; 62: 51–55.

[20] McClung MR, Lippuner K, Brandi ML, Zanchetta JR, Bone HG, Chapurlat R, et al. Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis. Osteoporosis International. 2017; 28: 2967–2973.

[21] Shevroja E, Lamy O, Kohlmeier L, Koromani F, Rivadeneira F, Hans D. Use of trabecular bone score (TBS) as a complementary approach to dual-energy X-ray absorptiometry (DXA) for fracture risk assessment in clinical practice. Journal of Clinical Densitometry. 2017; 20: 334–345.

[22] Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi ML, Cooper C, et al. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone. 2015; 78: 216–224.

[23] Bréban S, Briot K, Kolta S, Paternotte S, Ghazi M, Fechtenbaum J, et al. Identification of rheumatoid arthritis patients with vertebral fractures using bone mineral density and trabecular bone score. Journal of Clinical Densitometry. 2012; 15: 260–266.

[24] Pothuaud L, Barthe N, Krieg M, Mehsen N, Carceller P, Hans D. Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: a preliminary spine BMD-Matched, Case-Control Study. Journal of Clinical Densitometry. 2009; 12: 170–176.

[25] Briot K, Paternotte S, Kolta S, Eastell R, Reid DM, Felsenberg D, et al. Added value of trabecular bone score to bone mineral density for prediction of osteoporotic fractures in postmenopausal women: the OPUS study. Bone. 2013; 57: 232–236.

[26] Boutroy S, Hans D, Sornay-Rendu E, Vilayphiou N, Winzenrieth R, Chapurlat R. Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study. Osteoporosis International. 2013; 24: 77–85.

[27] McCloskey EV, Odén A, Harvey NC, Leslie WD, Hans D, Johansson H, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. Journal of Bone and Mineral Research. 2016; 31: 940–948.

[28] Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporosis International. 2000; 11: 669–674.

[29] Johnston CB, Dagar M. Osteoporosis in older adults. Medical Clinics of North America. 2020; 104: 873–884.

[30] Lu Y, Lin YC, Lin Y, Liu Y, Chang K, Chieng P, et al. Prevalence of osteoporosis and low bone mass in older chinese population based on bone mineral density at multiple skeletal sites. Scientific Reports. 2016; 6: 25206.

[31] Chuang TL, Chuang MH, Wang YF, Koo M. Age-specific normative values of lumbar spine trabecular bone score (TBS) in Taiwanese men and women. Journal of Clinical Medicine. 2021; 10: 4740.

[32] Park SY, Kim JH, Choi HJ, Ku EJ, Hong AR, Lee JH, et al. Longitudinal changes in bone mineral density and trabecular bone score in Korean adults: a community-based prospective study. Archives of Osteoporosis. 2020; 15: 100.

[33] Anderson KB, Holloway-Kew KL, Hans D, Kotowicz MA, Hyde NK, Pasco JA. Reference ranges for trabecular bone score in Australian men and women: a cross-sectional study. JBMR Plus. 2019; 3: e10133.

[34] Anderson KB, Holloway-Kew KL, Hans D, Kotowicz MA, Hyde NK, Pasco JA. Physical and lifestyle factors associated with trabecular bone score values. Archives of Osteoporosis. 2020; 15: 177.

[35] Mazzetti G, Berger C, Leslie WD, Hans D, Langsetmo L, Hanley DA, et al. Densitometer-specific differences in the correlation between body mass index and lumbar spine trabecular bone score. Journal of Clinical Densitometry. 2017; 20: 233–238.

[36] Guagnelli M, Winzenrieth R, Deleze M, Cons-Molina F, Clark P. Description of normative spine TBS data for men and women in mexican population. Journal of Clinical Densitometry. 2021; 24: 129–134.

[37] Sritara C, Thakkinstian A, Ongphiphadhanakul B, Amnuaywattakorn S, Utamakul C, Akrawichien T, et al. Age-adjusted dual x-ray absorptiometry-derived trabecular bone score curve for the Lumbar spine in Thai females and males. Journal of Clinical Densitometry. 2016; 19: 494–501.

[38] Rajaei A, Amiri A, Farsad F, Dehghan P. The correlation between trabecular bone score and lumbar spine bone mineral density in patients with normal and high body mass index. Iranian Journal of Medical Sciences. 2019; 44: 374–381.

[39] Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC. Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporosis International. 1997; 7: 564–569.

[40] Wildberger L, Boyadzhieva V, Hans D, Stoilov N, Rashkov R, Aubry-Rozier B. Impact of lumbar syndesmophyte on bone health as assessed by bone density (BMD) and bone texture (TBS) in men with axial spondyloarthritis. Joint Bone Spine. 2017; 84: 463–466.

[41] Ito M, Hayashi K, Yamada M, Uetani M, Nakamura T. Relationship of osteophytes to bone mineral density and spinal fracture in men. Radiology. 1993; 189: 497–502.

[42] Anderson KB, Holloway-Kew KL, Mohebbi M, Kotowicz MA, Hans D, Pasco JA, et al. Is trabecular bone score less affected by degenerative-changes at the spine than lumbar spine BMD? Archives of Osteoporosis. 2018; 13: 127.

[43] Shin YH, Gong HS, Lee KJ, Baek GH. Older age and higher body mass index are associated with a more degraded trabecular bone score compared to bone mineral density. Journal of Clinical Densitometry. 2019; 22: 266–271.

[44] Lee J, Kim KM, Kim L, Kim KY, Oh TJ, Moon JH, et al. Comparisons of TBS and lumbar spine BMD in the associations with vertebral fractures according to the T-scores: a cross-sectional observation. Bone. 2017; 105: 269–275.

[45] Su Y, Leung J, Hans D, Aubry-Rozier B, Kwok T. Added clinical use of trabecular bone score to BMD for major osteoporotic fracture prediction in older Chinese people: the Mr. OS and Ms. OS cohort study in Hong Kong. Osteoporosis International. 2017; 28: 151–160.

[46] Langsetmo L, Vo TN, Ensrud KE, Taylor BC, Cawthon PM, Schwartz AV, et al. The association between trabecular bone score and lumbar spine volumetric BMD is attenuated among older men with high body mass index. Journal of Bone and Mineral Research. 2016; 31: 1820–1826.

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