Observational studyRheumatology (Oxford, England)2026
Is trabecular bone score associated with multiple fragility fractures? Evidence from a large observational cohort study.
Observational study in Rheumatology (Oxford, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTrabecular bone score (TBS) is a measure of bone microarchitecture associated with hip and major osteoporotic fractures. However, TBS has not been evaluated in UK-specific cohorts, and little is known about its association with multiple fragility fracture phenotypes; this study aimed to investigate these associations.
methodsTBS was available in a subset of patients referred for dual-energy X-ray absorptiometry assessment in northwest England between June 2004 and May 2025. Fragility fracture phenotypes were defined as a single hip fracture (SHF), single non-hip fracture (SNHF), multiple non-hip fractures (MNHF) and multiple fractures including at least one hip fracture (MFH). These categories served as the dependent variable in a multinomial logistic regression model. Ordinal logistic regression models assessed associations with ordered hip and non-hip fracture categories. All models were adjusted for FRAX variables and the mean TBS, with multiple comparisons accounted for using Bonferroni correction.
resultsA total of 2782 patients were included, with a mean age of 66.84 years (SD 12.31), mean BMI of 27.31 kg/m2 (SD 5.91), and 2146 (77.2%) were female. Lower TBS was associated with SNHF (OR 1.37, 95% CI 1.28-1.48), MNHF (OR 1.32, 95% CI 1.27-1.36) and MFH (OR 1.68, 95% CI 1.16-2.43). In ordinal models, lower TBS was associated with increasing fracture burden within the non-hip fracture groups (OR 1.31, 95% CI 1.16-1.47) but was not associated with SHF or the hip fracture groups.
conclusionTBS is associated with multiple fragility fracture phenotypes and greater fracture burden within non-hip fracture categories.
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