- Findings support the use of routine X-rays to help identify individuals at very high bone fragility risk who may benefit from further bone health evaluation
- TBS Reveal™ demonstrated robust performance across international and ethnically diverse populations in a multicentre dataset comprising 18,858 radiographs of the lumbar spine with paired DXA scans from 11,138 adults
Geneva, Switzerland — May 28, 2026
New research published in eClinicalMedicine, part of The Lancet Discovery Science (Validation of a deep learning model for bone fragility detection from conventional radiographs: an international cohort study), shows that TBS Reveal™, an AI software under development by Medimaps, can identify individuals at risk of fracture due to bone fragility directly from routine X-rays that include two or more lumbar vertebrae.
Fragility fractures are among the most common, costly, and preventable causes of morbidity and mortality worldwide, yet most individuals who sustain a fragility fracture were never identified as at-risk beforehand.
Two persistent challenges help explain this gap. First, current screening pathways rely heavily on DXA, a dedicated imaging modality that is not universally accessible. Second, while DXA-derived BMD is central to osteoporosis diagnosis, BMD alone does not fully capture fracture risk, with many fragility fractures occurring in individuals with osteopenia or even normal BMD.
Medimaps Group — the creators of TBS® (Trabecular Bone Score®), the global standard for bone microarchitecture assessment from DXA — designed TBS Reveal to address both of these challenges. TBS Reveal derives a composite Bone Fragility Index, combining BMD with Medimaps Group’s patented TBS technology to assess both bone quantity and quality in a single opportunistic measurement. It does this by applying advanced image feature analysis and artificial intelligence to routine radiographs of the spine, abdomen, chest, or pelvis that include two or more lumbar vertebrae.
TBS is an established index of bone microarchitecture, which reflects the internal structure or quality of bone tissue. While BMD captures how much bone is present, microarchitecture determines how well that bone is organised. Supported by over 1,600 publications and integrated into clinical guidelines worldwide, TBS is an established complement to BMD in fracture risk assessment and the scientific foundation on which TBS Reveal is built.
This study reflects the next evolution of Medimaps’ bone health strategy. For more than a decade, we have helped clinicians go beyond bone density alone by providing TBS from DXA, adding clinically relevant information on bone microarchitecture. With TBS Reveal, we are extending that scientific foundation to routine X-rays — helping close a major clinical gap by identifying patients at high bone fragility risk who may otherwise remain undetected until a fragility fracture occurs.
said Didier Hans, CEO and Co-founder of Medimaps.
Backed by strong clinical evidence
TBS Reveal™ has been validated through international, multi-centre cohort studies. A study published in eClinicalMedicine (part of The Lancet Discovery Science) in 2026 demonstrated strong potential for identifying bone-fragility risk from conventional radiographs.²
“This certification validates years of rigorous clinical development. Fragility fractures cost European health systems an estimated €57 billion annually, and the imaging needed to intervene earlier is, in many cases, already being performed,"
said Gino Fiore, Chief Commercial Officer at Medimaps.
TBS Reveal™ reads routine X-rays within existing radiology workflows. It was added to Medimaps’s MDR certificate (no. C831120, issued by DNV Product Assurance AS, notified body 2460) on 25 June 2026. The certification makes TBS Reveal™ available for clinical use across Europe, enabling clinicians to identify bone-fragility risk from X-rays already being captured in routine care. FDA clearance is pending; TBS Reveal™ is not available for clinical use in the United States.
What’s next for TBS Reveal
CE certification is a milestone, not a destination. Because TBS Reveal™ draws its insight from imaging that is already being performed, it points toward a future in which bone fragility can be identified opportunistically, wherever an X-ray is taken, long before a first fracture forces the question.
Realizing that future means widening access: continuing to build the clinical evidence base and pursuing further regulatory clearances, including in the United States.
"An osteoporotic fracture should be the thing we prevent, not the event that finally prompts a diagnosis. Certification in Europe is the first step toward putting opportunistic bone-health assessment within reach of every clinician who already relies on X-ray, and toward an era where healthy bones are the norm,"
said Didier Hans.
Regulatory status may vary by market and may have changed since this article's publication date. For current regulatory information about TBS Reveal™, visit the TBS Reveal™ product page.
References:
1. Compston, J. (2020). Reducing the treatment gap in osteoporosis. The Lancet Diabetes & Endocrinology, 8(1), pp.7–9. doi:10.1016/S2213-8587(19)30378-X
2. Gatineau, G., De Gruttola, M., Hind, K., Davies, M., Krueger, D., Binkley, N., Kužma, M., Payer, J., Guglielmi, G., Fahrleitner-Pammer, A., Chun, K., Bencardino, J., Sherman, A., Jones, K. and Hans, D. (2026). Validation of a deep learning model for bone fragility detection from conventional radiographs: an international cohort study. eClinicalMedicine, 95, p.103974. doi:10.1016/j.eclinm.2026.103974