{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:11:44Z","timestamp":1772118704826,"version":"3.50.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T00:00:00Z","timestamp":1706313600000},"content-version":"vor","delay-in-days":1152,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":790,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Lumbar spine trabecular bone score (TBS), a gray-level texture measure derived from spine dual-energy X-ray absorptiometry (DXA) images, is a bone mineral density (BMD)-independent risk factor for fracture. An unresolved question is whether TBS is sufficiently responsive to change over time or in response to widely used osteoporosis therapy at the individual level to serve as a useful biomarker. Using the Manitoba DXA Registry, we identified 11,643 individuals age 40\u2009years and older with two fan-beam DXA scans performed on the same instrument within 5\u2009years (mean interval 3.2\u2009years), of whom 6985 (60.0%) received antiresorptive osteoporosis medication (majority oral bisphosphonate) between the scans. We examined factors that were associated with a change in lumbar spine TBS, lumbar spine BMD, and total hip BMD exceeding the 95% least significant change (LSC). Change exceeding the LSC was identified in 23.0% (9.3% increase, 13.8% decrease) of lumbar spine TBS, 38.2% (22.1% increase, 16.1% decrease) lumbar spine BMD, and 42.5% (17.6% increase, 24.9% decrease) total hip BMD measurement pairs. From regression models, the variables most strongly associated with significant change in TBS (decreasing order) were tissue thickness change, acquisition mode change, weight change, and spine percent fat change. Consistent with the insensitivity of TBS to oral antiresorptive therapies, use of these agents showed very little effect on TBS change. In contrast, for both spine BMD change and total hip BMD change, osteoporosis medication use was the most significant variable, whereas tissue thickness change, acquisition mode change, and weight change had relatively weak effects. In summary, change in spine TBS using the present algorithm appears to be strongly affected by technical factors. This suggests a limited role, if any, for using TBS change in untreated individuals or for monitoring response to antiresorptive treatment in routine clinical practice with the current version of the TBS algorithm. \u00a9 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4774","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T06:54:59Z","timestamp":1674111299000},"page":"512-521","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Contributions of Clinical and Technical Factors to Longitudinal Change in Trabecular Bone Score and Bone Density: A Registry-Based Individual-Level Analysis"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1056-1691","authenticated-orcid":false,"given":"William D","family":"Leslie","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Manitoba Winnipeg Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heenam","family":"Goel","sequence":"additional","affiliation":[{"name":"CentraCare St. Cloud MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9905-461X","authenticated-orcid":false,"given":"Neil","family":"Binkley","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health Madison WI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0177-8140","authenticated-orcid":false,"given":"Eugene V","family":"McCloskey","sequence":"additional","affiliation":[{"name":"Centre for Metabolic Bone Diseases University of Sheffield Medical School Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Didier","family":"Hans","sequence":"additional","affiliation":[{"name":"Bone and Joint Department Lausanne University Hospital Lausanne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"issue":"6","key":"2024012714100125800_jbmr4774-bib-0001","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/0002-9343(93)90218-E","article-title":"Consensus Development Conference: diagnosis, prophylaxis, and treatment of osteoporosis","volume":"94","year":"1993","journal-title":"Am J Med."},{"issue":"6","key":"2024012714100125800_jbmr4774-bib-0002","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1503\/cmaj.070234","article-title":"Low bone mineral density and fracture burden in postmenopausal women","volume":"177","author":"Cranney","year":"2007","journal-title":"Can Med Assoc J."},{"issue":"11","key":"2024012714100125800_jbmr4774-bib-0003","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1359\/jbmr.2003.18.11.1947","article-title":"BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures","volume":"18","author":"Stone","year":"2003","journal-title":"J Bone Miner Res."},{"key":"2024012714100125800_jbmr4774-bib-0004","first-page":"277","volume-title":"Primer on the metabolic bone diseases and disorders of mineral metabolism","author":"Silva","year":"2019","edition":"9th ed"},{"issue":"6","key":"2024012714100125800_jbmr4774-bib-0005","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1007\/s00223-015-9980-x","article-title":"Adjusting fracture probability by trabecular bone score","volume":"96","author":"McCloskey","year":"2015","journal-title":"Calcif Tissue Int."},{"issue":"3","key":"2024012714100125800_jbmr4774-bib-0006","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jocd.2015.06.013","article-title":"Executive summary of the 2015 ISCD Position Development Conference on Advanced Measures from DXA and QCT: fracture prediction beyond BMD","volume":"18","author":"Shepherd","year":"2015","journal-title":"J Clin Densitom."},{"issue":"1","key":"2024012714100125800_jbmr4774-bib-0007","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s11657-022-01061-5","article-title":"UK clinical guideline for the prevention and treatment of osteoporosis","volume":"17","author":"Gregson","year":"2022","journal-title":"Arch Osteoporos."},{"issue":"10","key":"2024012714100125800_jbmr4774-bib-0008","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00198-021-05900-y","article-title":"The clinician's guide to prevention and treatment of osteoporosis","volume":"33","author":"LeBoff","year":"2022","journal-title":"Osteoporos Int."},{"issue":"4","key":"2024012714100125800_jbmr4774-bib-0009","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.jocd.2019.07.006","article-title":"Dual-energy X-ray absorptiometry monitoring with trabecular bone score: the 2019 ISCD official positions","volume":"22","author":"Krohn","year":"2019","journal-title":"J Clin Densitom."},{"issue":"3","key":"2024012714100125800_jbmr4774-bib-0010","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.jocd.2015.06.008","article-title":"Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 2: trabecular bone score","volume":"18","author":"Silva","year":"2015","journal-title":"J Clin Densitom."},{"issue":"10169","key":"2024012714100125800_jbmr4774-bib-0011","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/S0140-6736(18)32112-3","article-title":"Osteoporosis","volume":"393","author":"Compston","year":"2019","journal-title":"Lancet."},{"issue":"1","key":"2024012714100125800_jbmr4774-bib-0012","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1002\/jbmr.4433","article-title":"Validation of the surrogate threshold effect for change in bone mineral density as a surrogate endpoint for fracture outcomes: the FNIH-ASBMR SABRE project","volume":"37","author":"Eastell","year":"2022","journal-title":"J Bone Miner Res."},{"issue":"4","key":"2024012714100125800_jbmr4774-bib-0013","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1002\/jbmr.3641","article-title":"Change in bone density and reduction in fracture risk: a meta-regression of published trials","volume":"34","author":"Bouxsein","year":"2019","journal-title":"J Bone Miner Res."},{"issue":"7","key":"2024012714100125800_jbmr4774-bib-0014","doi-asserted-by":"crossref","first-page":"465","DOI":"10.7326\/M15-2937","article-title":"Change in bone mineral density is an indicator of treatment-related antifracture effect in routine clinical practice: a registry-based cohort study","volume":"165","author":"Leslie","year":"2016","journal-title":"Ann Intern Med."},{"issue":"3","key":"2024012714100125800_jbmr4774-bib-0015","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1002\/jbmr.3054","article-title":"Change in trabecular bone score (TBS) with antiresorptive therapy does not predict fracture in women: the Manitoba BMD cohort","volume":"32","author":"Leslie","year":"2017","journal-title":"J Bone Miner Res."},{"key":"2024012714100125800_jbmr4774-bib-0016","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12891-016-0886-1","article-title":"Simulated increased soft tissue thickness artefactually decreases trabecular bone score: a phantom study","volume":"17","author":"Amnuaywattakorn","year":"2016","journal-title":"BMC Musculoskelet Disord."},{"issue":"2","key":"2024012714100125800_jbmr4774-bib-0017","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jocd.2016.11.003","article-title":"Densitometer-specific differences in the correlation between body mass index and lumbar spine trabecular bone score","volume":"20","author":"Mazzetti","year":"2017","journal-title":"J Clin Densitom."},{"issue":"1","key":"2024012714100125800_jbmr4774-bib-0018","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s00198-017-4273-z","article-title":"Predictors of change of trabecular bone score (TBS) in older men: results from the Osteoporotic Fractures in Men (MrOS) study","volume":"29","author":"Schousboe","year":"2018","journal-title":"Osteoporos Int."},{"issue":"6 Suppl","key":"2024012714100125800_jbmr4774-bib-0019","first-page":"JS10","article-title":"Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system","volume":"37","author":"Roos","year":"1999","journal-title":"Med Care."},{"issue":"3","key":"2024012714100125800_jbmr4774-bib-0020","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1385\/JCD:6:3:275","article-title":"Establishing a regional bone density program: lessons from the Manitoba experience","volume":"6","author":"Leslie","year":"2003","journal-title":"J Clin Densitom."},{"issue":"1","key":"2024012714100125800_jbmr4774-bib-0021","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1385\/JCD:8:1:025","article-title":"Construction and validation of a population-based bone densitometry database","volume":"8","author":"Leslie","year":"2005","journal-title":"J Clin Densitom."},{"issue":"11","key":"2024012714100125800_jbmr4774-bib-0022","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1359\/jbmr.1997.12.11.1761","article-title":"Prevalence of low femoral bone density in older U.S. adults from NHANES III","volume":"12","author":"Looker","year":"1997","journal-title":"J Bone Miner Res."},{"issue":"11","key":"2024012714100125800_jbmr4774-bib-0023","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1345\/aph.18117","article-title":"Validation of an electronic, population-based prescription database","volume":"32","author":"Kozyrskyj","year":"1998","journal-title":"Ann Pharmacother."},{"issue":"8","key":"2024012714100125800_jbmr4774-bib-0024","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1002\/jbmr.3726","article-title":"Performance of FRAX in women with breast cancer initiating aromatase inhibitor therapy: a registry-based cohort study","volume":"34","author":"Leslie","year":"2019","journal-title":"J Bone Miner Res."},{"issue":"4","key":"2024012714100125800_jbmr4774-bib-0025","first-page":"190","article-title":"A review of the logistic regression model with emphasis on medical research","volume":"7","author":"Boateng","year":"2019","journal-title":"J Data Anal Inform Process."},{"key":"2024012714100125800_jbmr4774-bib-0026","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.bone.2014.12.062","article-title":"Comparison between different bone treatments on areal bone mineral density (aBMD) and bone microarchitectural texture as assessed by the trabecular bone score (TBS)","volume":"75","author":"Di Gregorio","year":"2015","journal-title":"Bone."},{"issue":"2","key":"2024012714100125800_jbmr4774-bib-0027","doi-asserted-by":"crossref","first-page":"117","DOI":"10.11005\/jbm.2017.24.2.117","article-title":"Longitudinal change in trabecular bone score during and after treatment of osteoporosis in postmenopausal Korean women","volume":"24","author":"Shin","year":"2017","journal-title":"J Bone Metab."},{"issue":"4","key":"2024012714100125800_jbmr4774-bib-0028","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jocd.2016.01.002","article-title":"The effect of changing scan mode on trabecular bone score using lunar prodigy","volume":"19","author":"Chen","year":"2016","journal-title":"J Clin Densitom."},{"issue":"4","key":"2024012714100125800_jbmr4774-bib-0029","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s00256-014-1980-9","article-title":"Reproducibility of trabecular bone score with different scan modes using dual-energy X-ray absorptiometry: a phantom study","volume":"44","author":"Bandirali","year":"2015","journal-title":"Skeletal Radiol."},{"issue":"7","key":"2024012714100125800_jbmr4774-bib-0030","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1007\/s00330-015-3606-6","article-title":"Short-term precision assessment of trabecular bone score and bone mineral density using dual-energy X-ray absorptiometry with different scan modes: an in vivo study","volume":"25","author":"Bandirali","year":"2015","journal-title":"Eur Radiol."},{"issue":"12","key":"2024012714100125800_jbmr4774-bib-0031","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1002\/jbmr.3851","article-title":"Clinical performance of the updated trabecular bone score (TBS) algorithm, which accounts for the soft tissue thickness: the OsteoLaus study","volume":"34","author":"Shevroja","year":"2019","journal-title":"J Bone Miner Res."},{"issue":"5","key":"2024012714100125800_jbmr4774-bib-0032","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/cen.13000","article-title":"Management recommendations for osteoporosis in clinical guidelines","volume":"84","author":"Wang","year":"2016","journal-title":"Clin Endocrinol."},{"issue":"6","key":"2024012714100125800_jbmr4774-bib-0033","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1210\/clinem\/dgac051","article-title":"Apparent \"rapid loss\" after short-interval bone density testing in menopausal women is usually a measurement artifact","volume":"107","author":"Kline","year":"2022","journal-title":"J Clin Endocrinol Metab."},{"issue":"12","key":"2024012714100125800_jbmr4774-bib-0034","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1056\/NEJMoa030897","article-title":"Ten years' experience with alendronate for osteoporosis in postmenopausal women","volume":"350","author":"Bone","year":"2004","journal-title":"N Engl J Med."},{"issue":"6","key":"2024012714100125800_jbmr4774-bib-0035","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1002\/jbmr.3722","article-title":"Relationship between bone mineral density T-score and nonvertebral fracture risk over 10\u2009years of denosumab treatment","volume":"34","author":"Ferrari","year":"2019","journal-title":"J Bone Miner Res."},{"issue":"1","key":"2024012714100125800_jbmr4774-bib-0036","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11657-018-0501-1","article-title":"Effect of vertebral exclusion on TBS and FRAX calculations","volume":"13","author":"White","year":"2018","journal-title":"Arch Osteoporos."},{"issue":"2","key":"2024012714100125800_jbmr4774-bib-0037","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.jocd.2014.11.003","article-title":"Spine trabecular bone score precision, a comparison between GE lunar standard and high-resolution densitometers","volume":"18","author":"Krueger","year":"2015","journal-title":"J Clin Densitom."},{"issue":"2","key":"2024012714100125800_jbmr4774-bib-0038","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1359\/jbmr.071019","article-title":"Factors affecting short-term bone density precision assessment and the effect on patient monitoring","volume":"23","author":"Leslie","year":"2008","journal-title":"J Bone Miner Res."}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jbmr.4774","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jbmr.4774","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/38\/4\/512\/55456609\/jbmr4774.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/38\/4\/512\/55456609\/jbmr4774.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T10:47:01Z","timestamp":1710326821000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/38\/4\/512-521\/7500036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,1]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,1,19]]},"published-print":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.4774","relation":{"has-review":[{"id-type":"doi","id":"10.1002\/JBMR.4774\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/JBMR.4774\/v2\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/JBMR.4774\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/JBMR.4774\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/JBMR.4774\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/JBMR.4774\/v2\/decision1","asserted-by":"object"}]},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,12,1]]},"published":{"date-parts":[[2020,12,1]]},"assertion":[{"value":"2022-11-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}