Advancing trabecular bone score (TBS): clinical performance of TBS version 4.0 with direct correction for soft tissue thickness—the osteolaus study
Authors' conclusion
TBS v4.0 enhances the adjustment for regional soft tissue effects and results suggest comparable vertebral fracture risk prediction to TBS v3.
Study context
- Population
- OsteoLaus cohort
- Exposure
- TBS v4.0 vs TBS v3
- Outcome
- Performance of TBS v4.0 vs v3 for bone health evaluation and fracture risk assessment across diverse body compositions
Methodological detailscomparison of TBS v4.0 vs TBS v3, machine learning (Random Forest, SHAP), logistic regression, Delong's test
- Comparison of TBS v4.0 vs TBS v3
- Machine learning (Random Forest, SHAP)
- Logistic regression
- Delong's test
Main finding
As reported in the abstract
Correlations of TBS with body composition
| Group | R with body mass index (BMI) | R with visceral fat (VFAT) mass | R with soft tissue thickness |
|---|---|---|---|
| TBS v3 | 0.110, p < 0 .001 | - 0.162, p < 0 .001 | - 0.165, p < 0.001 |
| TBS v4.0 | - 0.057, p > 0.999 | - 0.067, p > 0.779 | - 0.114, p = 0.019 |
R with body mass index (BMI)
TBS v30.110, p < 0 .001
TBS v4.0- 0.057, p > 0.999
R with visceral fat (VFAT) mass
TBS v3- 0.162, p < 0 .001
TBS v4.0- 0.067, p > 0.779
R with soft tissue thickness
TBS v3- 0.165, p < 0.001
TBS v4.0- 0.114, p = 0.019
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Vertebral fracture prediction (logistic regression, DeLong's test)No significant differences | P = 0.564 |
FRAX adjustments, consistency between TBS versions
- Correlation of FRAX adjustments between versions (r)
- 0.994
- P (correlation)
- P < 0.001
- No evidence of calibration bias (P)
- P = 0.241
Original publication
Advancing trabecular bone score (TBS): clinical performance of TBS version 4.0 with direct correction for soft tissue thickness—the osteolaus study. Osteoporos Int. Published 4 March 2025. doi:10.
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