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Clinical application
TBS in the management of patients with cancer
Some cancer treatments cause significant bone loss and secondary osteoporosis. TBS® complements BMD and FRAX® to detect that fracture risk earlier, including in patients who look fine on density alone.
Background
Advances in cancer prevention, detection, and treatment have significantly increased survival.1 But while treatments have become more effective, one complication of some therapies is secondary osteoporosis: Loss of bone mass and degradation of bone microarchitecture that raises fracture risk.2
Why bone quality matters with cancer
Some cancer treatments can reduce the levels of certain hormones, which can cause bone thinning. Treatments for breast cancer in women and prostate cancer in men are associated with especially high rates of bone loss.
- Chemotherapy, hormonal therapy, and glucocorticoids can all drive significant bone loss.2
- Aromatase inhibitors (first-line therapy for postmenopausal women with hormone-receptor-positive breast cancer) are known to accelerate bone turnover and increase fragility-fracture risk.4
- Androgen-deprivation therapy is associated with bone loss in men with prostate cancer, and cumulative fracture risk rises with longer treatment.5
- Osteoporosis is also roughly twice as common in young adults after haematopoietic stem-cell transplantation, with about a 1.4x higher fracture risk.6
13% → 20%
In women with early hormone-positive breast cancer on aromatase inhibitors, BMD and FRAX® identified 13% with elevated fracture risk. Adding TBS® raised that to 20%.1
Cancer treatment–induced bone loss
DXA is frequently recommended before and during cancer treatment, and is repeated as clinically indicated.
Trabecular Bone Score® is a validated index of bone microarchitecture, acquired at the same time as BMD during a DXA scan, and identifies normal, partially degraded, or degraded microarchitecture. Adding TBS® helps identify at-risk patients who are non-osteoporotic by BMD alone.
TBS® can predict fracture independent of BMD and clinical risk factors, as trabecular bone is affected in most causes of secondary osteoporosis.3
Summary
TBS® is a valuable complement to BMD in oncology — especially for patients on therapies known to affect bone, such as aromatase inhibitors and androgen-deprivation therapy — helping clinicians identify and manage osteoporosis risk more accurately.
TBS in secondary osteoporsis
Cancer
Diabetes
HIV
Endocrine disorders
Chronic kidney disease, coming soon
Glucocorticoid-induced, coming soon
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.
References (6)
1. Kocarnik, J.M., Compton, K., Dean, F.E., Fu, W., Gaw, B.L., et al. (2022). Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019. JAMA Oncology, [online] 8(3), p.420. doi:10.1001/jamaoncol.2021.6987.
2. Bhatia, R., Holtan, S., Jurdi, N. El, Prizment, A. and Blaes, A. (2022). Do Cancer and Cancer Treatments Accelerate Aging? Current Oncology Reports, [online] 24(11), pp.1401–1412. doi:10.1007/s11912-022-01311-2.
3. Shevroja, E., Reginster, J.-Y., Lamy, O., Al-Daghri, N., Chandran, M., Demoux-Baiada, A.-L., Kohlmeier, L., Lecart, M.-P., Messina, D., Camargos, B.M., Payer, J., Tuzun, S., Veronese, N., Cooper, C., McCloskey, E.V. and Harvey, N.C. (2023). Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging. Osteoporosis International, [online] 34(9), pp.1501–1529. doi:10.1007/s00198-023-06817-4.
4. Shapiro, C.L., Lacchetti, C. and Neuner, J. (2019). Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease: ASCO Clinical Practice Guideline Summary. Journal of Oncology Practice, [online] 15(12), pp.665–669. doi:10.1200/jop.19.00427.
5. Taplin, M.-E., Riaz, I. Bin, Rumble, R.B., Naqvi, S.A.A., Hope, T.A., Dias, M.F., He, H., Hotte, S.J., Emamekhoo, H., Murad, M.H., Celano, P., Kungel, T.M., Hentzen, S., Serzan, M.T. and Parikh, R.A. (2026). Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: ASCO Living Guideline, Version 2026.1. Journal of Clinical Oncology, [online] 44(6). doi:10.1200/jco-25-02693.
6. Lin, J.-N., Chen, H.-J., Yang, C.-H., Lai, C.-H., Lin, H.-H., Chang, C.-S. and Liang, J.-A. (2017). Risk of osteoporosis and pathologic fractures in cancer patients who underwent hematopoietic stem cell transplantation: a nationwide retrospective cohort study. Oncotarget, [online] 8(21), pp.34811–34819. doi:10.18632/oncotarget.16746.