Elevated values of TBS correlate with fracture resistance, whereas porous osteoporotic bone depict lower values than normal bone [44]. The advantages of TBS are that it can be assessed retrospectively from previously obtained DXA scans providing longitudinal data, and it is not impacted by the presence of overlying calcifications or degenerative changes in the spine [45]. In the setting of screening or initial imaging, TBS is regarded as an adjunct tool to DXA. However, TBS should not be used alone in clinical practice either to screen for osteoporosis or for treatment decisions [17]. TBS may be useful in certain populations. TBS when used in conjunction with BMD, clinical risk factors, and/or FRAX consistently enhances their accuracy [46-50]. Significantly reduced TBSs are associated with fragility fractures in secondary osteoporosis. In these patients, TBS has been found to have a substantially higher association with fracture risk than BMD [51,52]. TBSs in patients with type 2 diabetes, chronic renal disease, glucocorticoid therapy, rheumatoid arthritis, and hyperparathyroidism have demonstrated increased fracture risk, even in the setting of normal BMD [47,53]. Variant 2: Follow-up imaging of patients demonstrated to have risk for fracture or surveillance of established low bone mineral density. Follow-up imaging is recommended in patients who have increased risk for fracture, been previously diagnosed with osteopenia or osteoporosis, or initiated treatment for osteoporosis. Additionally, as outlined in Variant 3, vertebral fracture assessment (VFA) may be considered in patients with documented spine fractures or if they have Osteoporosis and Bone Mineral Density been diagnosed with osteopenia and meet certain age criteria, have experienced height loss or undocumented vertebral fractures (VFs), or have a history of use of glucocorticoid medication for >3 months.
Osteoporosis and Bone Mineral Density. Elevated values of TBS correlate with fracture resistance, whereas porous osteoporotic bone depict lower values than normal bone [44]. The advantages of TBS are that it can be assessed retrospectively from previously obtained DXA scans providing longitudinal data, and it is not impacted by the presence of overlying calcifications or degenerative changes in the spine [45]. In the setting of screening or initial imaging, TBS is regarded as an adjunct tool to DXA. However, TBS should not be used alone in clinical practice either to screen for osteoporosis or for treatment decisions [17]. TBS may be useful in certain populations. TBS when used in conjunction with BMD, clinical risk factors, and/or FRAX consistently enhances their accuracy [46-50]. Significantly reduced TBSs are associated with fragility fractures in secondary osteoporosis. In these patients, TBS has been found to have a substantially higher association with fracture risk than BMD [51,52]. TBSs in patients with type 2 diabetes, chronic renal disease, glucocorticoid therapy, rheumatoid arthritis, and hyperparathyroidism have demonstrated increased fracture risk, even in the setting of normal BMD [47,53]. Variant 2: Follow-up imaging of patients demonstrated to have risk for fracture or surveillance of established low bone mineral density. Follow-up imaging is recommended in patients who have increased risk for fracture, been previously diagnosed with osteopenia or osteoporosis, or initiated treatment for osteoporosis. Additionally, as outlined in Variant 3, vertebral fracture assessment (VFA) may be considered in patients with documented spine fractures or if they have Osteoporosis and Bone Mineral Density been diagnosed with osteopenia and meet certain age criteria, have experienced height loss or undocumented vertebral fractures (VFs), or have a history of use of glucocorticoid medication for >3 months.