The Utility and Applicability of Risk Assessment Tools and Trabecular Bone Score

It is well known that BMD measured by DXA is a major determinant of bone strength and fracture risk, although most individuals with a fragility fracture will have a BMD in the osteopenic or even in the normal range. Skeletal and extraskeletal risk factors that contribute to overall fracture risk should be identified to better select patients for treatment. We report a case of a 51-year-old perimenopausal woman who sustained a typical osteoporotic fracture, despite not having osteoporosis by DXA. Her trabecular bone score (TBS), a gray-level texture measure derived from lumbar DXA images that provides an indirect index of bone architecture, was low. The patient’s 10-year probability of fracture by the Fracture Risk Assessment Tool (FRAX) was very high. The use of FRAX and TBS in clinical practice to identify patients that need pharmacological intervention and their role in monitoring antiosteoporotic therapy are reviewed.