Contribution of Trabecular Bone Score to Fracture Risk Stratification Beyond Bone Mineral Density in Women with Rheumatoid Arthritis: Results from a Cross-Sectional Cohort.

Objective: To assess the contribution of trabecular bone score (TBS) to fracture risk stratification, in relation to bone mineral density (BMD) and vertebral fractures, in women with rheumatoid arthritis (RA). Methods: This monocentric cross-sectional study included 152 women with RA who underwent dual-energy X-ray absorptiometry (DXA) with TBS evaluation. BMD was measured at the lumbar spine and femoral neck. TBS values were categorised as normal (≥1.300), partially degraded (1.200-1.299), or degraded (≤1.200). Vertebral fractures were identified by vertebral fracture assessment (VFA). Crude and multivariate logistic regression analyses were performed to identify predictors of degraded TBS. Results: Based on BMD, 38.8% of patients were osteoporotic, while 69.1% had degraded TBS values. Vertebral fractures were detected in 30.3% of patients. Notably, 23.6% showed discordance, with TBS values more degraded than expected from their BMD category. In multivariate analysis, lower lumbar spine BMD (OR 3.62, 95% CI 1.67-7.83, p=0.001) and longer corticosteroid exposure (OR 1.87, 95% CI 1.01-3.45, p=0.046) were independently associated with degraded TBS. Conclusion: TBS provides complementary information to BMD in evaluating bone quality and fracture risk in RA. Its integration into clinical practice may improve fracture risk stratification in this high-risk population.