Balneo and PRM Research Journal · Mar 31, 2026
Prevalence and Clinical Implications of BMD–TBS Discordance in Postmenopausal Women: A Real-World DXA Study
By Bot R, Nistor-Cseppento CD, Tirla AG et al.
Bone mineral density (BMD) alone may underestimate skeletal fragility, particularly in osteopenic women and in conditions characterized by a disproportionate deterioration of trabecular microarchitecture. Trabecular Bone Score (TBS) and the Bone Resilience Index (BRI) provide complementary information beyond BMD. We aimed to investigate the prevalence and clinical determinants of BMD–TBS discordance in a real-world cohort and to assess its implications for fracture risk reclassification. In this retrospective observa-tional study, we analyzed 110 postmenopausal women who underwent routine dual-energy X-ray absorptiometry (DXA), including lumbar spine TBS assessment and BRI extraction. BMD–TBS discordance was defined as normal or osteopenic hip BMD combined with partially degraded or degraded TBS. Clinical parameters, BMD, TBS, and BRI were evaluated in the entire cohort, while FRAX (Fracture Risk Assessment Tool) was available in a subgroup of patients (n = 34); multivariable regression analyses were per-formed to identify independent determinants of TBS. BMD–TBS discordance was observed in 78 of 110 women (70.9%; 95% CI: 61.5–78.9), peaking among those with hip osteopenia (82.8%). Higher body mass index (BMI) was positively correlated with BMD but inversely correlated with TBS, indicating a density–quality mismatch driven by adiposity-related microarchitectural deterioration. Discordance reached 86.0% in women with low BRI. In the FRAX subgroup (n = 34), 5 women (14.7%) were classified as low risk by FRAX alone despite high-risk microarchitecture, whereas 6 women (17.6%) showed potential risk overestimation, highlighting clinically relevant misclassification. BMD–TBS discordance is highly prevalent in routine clinical practice, particularly among osteopenic women and those with elevated BMI. Integrating TBS and BRI with BMD and FRAX may improve fracture risk discrimination and help avoid both undertreatment and overtreatment.