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Clinical applications
When other conditions weaken bone
Trabecular Bone Score® (TBS®) enriches fracture-risk assessment by capturing the structural information BMD leaves out — the bone microarchitecture that helps determine whether bone breaks.
Secondary osteoporosis
Bone fragility beyond age and menopause
Secondary osteoporosis is bone fragility caused by factors other than age and menopause, for example: Chronic diseases, endocrine disorders, and certain medications. It affects both the density and the quality of bone, and it's often silent until a fracture occurs.
Crucially, in many of these conditions, fracture risk stays high even when BMD is normal or elevated, because the damage is structural. That's exactly the gap TBS® was built to close: As a validated index of bone microarchitecture acquired from the same DXA scan, it captures degraded structure that density testing can't.
The clinical case
Trabecular bone is affected in most cases of secondary osteoporosis
TBS® can predict fracture independent of BMD and clinical risk factors, helping identify at-risk patients who are non-osteoporotic by BMD alone.
By condition
Explore TBS in in specific conditions
Cancer
Cancer treatment–induced bone loss from aromatase inhibitors, androgen-deprivation therapy, and glucocorticoids
Diabetes
High fracture risk despite normal or elevated BMD, driven by compromised bone quality
HIV
Osteoporosis as an HIV co-morbidity, with fractures occurring around a decade earlier
Endocrine disorders
Cushing's disease, insulin resistance, and primary hyperparathyroidism
Coming soon
Chronic kidney disease
Renal osteodystrophy and fracture risk beyond BMD
Coming soon
Glucocorticoid-induced
Steroid therapy and early microarchitectural decline
Explore the science
From the method to the evidence
Everything behind TBS®: The analytic method, the biology, the clinical applications, and the published record.
Trabecular Bone Score
Standardised, blinded central reading across all your sites, removing inter-site variability from your bone data
Bone microarchitecture
TBS® as a primary, secondary or safety endpoint, capturing microarchitectural change BMD can miss
TBS solutions
From the DXA suite to the X-ray reading room, our TBS® solutions add clinically meaningful bone insights
Publications
Documentation and QC aligned to an ISO 13485 quality system, ready for submission scrutiny
We help clinicians reveal more from routine imaging — every patient, every scan — for better care.
This content is for educational purposes for healthcare professionals and does not constitute medical advice or clinical guidance. It is not a substitute for the independent judgement of a qualified physician or specialist. Diagnostic and treatment decisions must be individualised to each patient, based on their complete clinical picture, locally applicable guidelines, and the most current evidence, which are determinations only a licensed healthcare provider is positioned to make.