EWBC provides Trabecular Bone Score (TBS) for eligible DXA patients

Bone mineral density (BMD) is traditionally measured in DXA scans to assess bone mass in women and men. TBS is an independent parameter besides the T score and BMD that provides an assessment of bone quality and microarchitecture, which contributes to bone strength. The TBS is a better indicator of bone strength than the bone density T score and a better predictor of fracture risk than DXA scores alone.  The integration of TBS with the BMD and a patient’s clinical picture adds value and allows the refinement of the fracture risk analysis, particularly in osteopenic patients.

TBS is measured from a lumbar spine DXA image so no extra scan is needed. It is most useful in patients with BMD values in the osteopenic range (-2.0 and -2.5) with a low TBS, as this may indicate a need to consider treatment. TBS is not affected by osteophytes or bony outgrowths (osteophytes) in arthritic patients, unlike BMD which is affected by arthritis and degenerative changes.

A high TBS value indicates dense bone microarchitecture and a lower risk of fracture, while a low TBS value reveals a weakened bone microarchitecture and a higher risk of fracture.

The graph above with the square in the red region indicates degraded mineral architecture.

There are some patients in which TBS cannot be calculated. These include but are not limited to:

  1. a BMI outside the range of 15-37 kg/m2
  2.  AP spine cannot be scanned
  3. Severe scoliosis

TBS should be interpreted in combination with BMD and clinical risk factors. It should not be used alone in determining treatment recommendations in clinical practice.

There may be rare instances where a TBS is ordered without a full DXA scan. This will be considered on a case-by-case basis. If this is requested, a script should be sent to indicate the clinical reason for the exam and the diagnosis code (77089), indicating “TBS only”.

Insurance coverage varies depending on the patient’s carrier and insurance plan.