Evidence map›Paper›PMID 40434688›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

Trabecular bone score predicts distal femur screw pull-out strength better than DXA bone mineral density, CT Hounsfield units, and cortical density.

James T Bernatz, Kevin P Sandhu, Diane Krueger, Gretta Borchardt, Keith A Knurr, Neil C Binkley, Joshua D Roth, Paul A Anderson

Abstract readEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

James T BernatzDepartment of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine & Public Health, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA. bernatz@ortho.wisc.edu.ORCID http://orcid.org/0000-0002-1480-4507
Kevin P SandhuDepartment of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine & Public Health, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.
Diane KruegerOsteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Ave. Ste. 100, Madison, WI, 53705, USA.
Gretta BorchardtOsteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Ave. Ste. 100, Madison, WI, 53705, USA.
Keith A KnurrDepartment of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine & Public Health, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.
Neil C BinkleyOsteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Ave. Ste. 100, Madison, WI, 53705, USA.
Joshua D RothDepartment of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine & Public Health, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.
Paul A AndersonDepartment of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine & Public Health, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The purpose of the study was to evaluate trabecular bone score (TBS) technology for orthopedic application (TBSortho) as a predictor of a screw pull-out strength in a cadaveric model. This study finds that TBSortho correlates more strongly with the screw pull-out strength compared to cortical density, computed tomography (CT) Hounsfield units (HU), and dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD).

introductionPatient bone quality impacts the mechanical strength of surgical fixation constructs. Preoperative assessments of bone quality and the potential for a screw pull-out are important for surgical planning as well as postoperative rehabilitation protocols. Previous work has correlated the screw pull-out strength with the screw insertional torque, cortical thickness, and CT HU. TBS is a gray-level textural metric that can be extracted from a two-dimensional DXA scan, improves fracture prediction, and may evaluate the mechanical competence of both the cortical and trabecular bones. The purpose of the study was to evaluate TBS technology for TBSortho as a predictor of the screw pull-out strength in a cadaveric model.

methodsTwenty paired, fresh-frozen cadaver femurs stripped of soft tissue were obtained (5 M, 5 F specimens, age range of 56-96 years). Standard clinical femur CT were performed to obtain HU, cortical thickness, and cortical density. DXA was also performed using a novel analysis technique as distal femur DXA is not routinely acquired clinically. DXA data were used to generate TBSortho values in two distal femur regions of interest. All femurs then underwent a screw pull-out testing with five lateral distal femoral 5-mm locking screws (n = 100 screws total). The correlation coefficient from Spearman tests and R-squared of the fixed effects from the linear mixed effects models were calculated.

resultsTBSortho was found to correlate most strongly of CT and DXA measures with the screw pull-out strength, having marginal R

conclusionThis study finds that TBSortho correlates more strongly with the screw pull out strength in a cadaveric distal femur model compared to cortical density, CT HU, and DXA BMD. These preliminary results suggest that TBSortho may be a valuable tool to model mechanical integrity of bone preoperatively.

Indexed as

Bone DensityBone ScrewsCancellous BoneFemurFracture Fixation, InternalAbsorptiometry, PhotonAgedAged, 80 and overCadaverCortical BoneFemaleHumansMaleMiddle AgedTomography, X-Ray ComputedComputed tomographyDual-energy X-ray absorptiometryTrabecular bone score

Identifiers

PMID40434688
PMCPMC12208966

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.