Osteoporosis and Bone Diseases · Aug 9, 2026
Consensus of experts of the Russian Osteoporosis Association on the use of trabecular bone index in clinical practice
By Lesnyak OM, Belaya ZE, Belova KY et al.
Traditionally, the assessment of fracture risk is based on measuring bone mineral density using dual-energy X-ray absorptiometry (densitometry). However, more than half of cases of low-energy fractures occur in patients with osteopenia or even normal BMD. The reason is that in addition to the bone mass, its microarchitecture is also important, which is not evaluated by standard densitometry. The trabecular bone score is a non-invasive, indirectly obtained indicator that characterizes the condition of trabecular bone tissue. It is determined by textural analysis of the image obtained during standard DXA of the lumbar spine in a direct projection. High values correspond to a well-organized, robust trabecular bone structure, while low values indicate a pronounced degradation of the microarchitecture. The trabecular bone score serves as an independent predictor of a decrease in bone strength, and combined with bone mineral density, it allows to more accurately predict fracture risk than each of these values separately. The score makes it possible to clarify the risk of both primary and secondary osteoporosis, and in clinical practice it is used as an additional parameter in assessing the risk of osteoporosis and fractures. Based on the literature data and their own experience, the experts of the Russian Association on Osteoporosis have formulated recommendations on the use of the trabecular bone score in clinical practice to more accurately determine the individual risk of fracture within the framework of personalized medicine.