{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:08:44Z","timestamp":1777914524534,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"5x1000 year 2020\u2014income 2019 (progetto 5x1000 anno 2020\u2014redditi 2019)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The trabecular bone score (TBS) estimates bone microarchitecture and can be used to evaluate the risk of osteoporotic fractures independently of bone mineral density (BMD). In this retrospective case-control study, we tested and compared the ability of TBS and lumbar spine BMD (LS-BMD) to predict vertebral fragility fractures. The inclusion criteria were female sex, age range 50\u201390 years, menopause, and clinical risk factors for osteoporosis. Patients with secondary osteoporosis were excluded. LS-BMD and TBS were measured at the L1\u2013L4 vertebral level. The ability of the two diagnostic systems in predicting vertebral fragility fractures was assessed by combining LS-BMD and TBS according to the Bayesian \u201cOR rule\u201d (the diagnosis is negative only for those negative for both tests, and it is positive for those who were positive for at least one test) or to the \u201cAND rule\u201d (the diagnosis is positive only for those positive to both tests and is negative for those negative for at least one test). Of the 992 postmenopausal women included, 86 had a documented vertebral fragility fracture. At the cutoff value used in the present study, the TBS and LS-BMD showed a similar diagnostic ability to predict vertebral fragility fractures, having positive predictive values (PPV) of, respectively, 13.19% and 13.24%. Negative predictive values (NPV) were, respectively, 95.40% and 94.95%. Compared to that of each single diagnostic system, the \u201cOR-rule\u201d significantly increased the NPV to 97.89%, while no statistically significant differences were found by using the \u201cAND-rule\u201d. In conclusion, the present study highlights the possibility that combining LS-BMD and TBS could improve their predictive ability in diagnosing vertebral fragility fractures, and that there is a significant probability of absence of fractures in women who test negative to both diagnostic systems.<\/jats:p>","DOI":"10.3390\/ijerph192114315","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T03:11:21Z","timestamp":1667445081000},"page":"14315","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Spine Fragility Fracture Prediction Using TBS and BMD in Postmenopausal Women: A Bayesian Approach"],"prefix":"10.3390","volume":"19","author":[{"given":"Claudio","family":"Ripamonti","sequence":"first","affiliation":[{"name":"Center for Osteoporosis and Bone Metabolic Diseases, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Lisi","sequence":"additional","affiliation":[{"name":"Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-7351","authenticated-orcid":false,"given":"Jacopo","family":"Ciaffi","sequence":"additional","affiliation":[{"name":"Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Buffa","sequence":"additional","affiliation":[{"name":"UOC Medicina Interna ad Indirizzo Reumatologico AUSL, 40133 Bologna, Italy"},{"name":"Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renata","family":"Caudarella","sequence":"additional","affiliation":[{"name":"Casa di Cura Privata Villalba, GVM Care & Research, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8194-8642","authenticated-orcid":false,"given":"Francesco","family":"Ursini","sequence":"additional","affiliation":[{"name":"Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40127 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.bone.2015.05.016","article-title":"Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice","volume":"78","author":"Harvey","year":"2015","journal-title":"Bone"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jocd.2011.05.005","article-title":"Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: An experimental study on human cadaver vertebrae","volume":"14","author":"Hans","year":"2011","journal-title":"J. Clin. Densitom."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.jocd.2012.05.001","article-title":"Three-dimensional (3D) microarchitecture correlations with 2D projection image gray-level variations assessed by trabecular bone score using high-resolution computed tomographic acquisitions: Effects of resolution and noise","volume":"16","author":"Winzenrieth","year":"2013","journal-title":"J. Clin. Densitom."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3432","DOI":"10.1007\/s00586-015-4035-6","article-title":"Bone mineral density (BMD) and vertebral trabecular bone score (TBS) for the identification of elderly women at high risk for fracture: The SEMOF cohort study","volume":"25","author":"Popp","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2762","DOI":"10.1002\/jbmr.499","article-title":"Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: The Manitoba study","volume":"26","author":"Hans","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/jbmr.2048","article-title":"Trabecular bone score (TBS) predicts vertebral fractures in Japanese women over 10 years independently of bone density and prevalent vertebral deformity: The Japanese Population-Based Osteoporosis (JPOS) cohort study","volume":"29","author":"Iki","year":"2014","journal-title":"J. Bone Miner. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.bone.2013.07.040","article-title":"Added value of trabecular bone score to bone mineral density for prediction of osteoporotic fractures in postmenopausal women: The OPUS study","volume":"57","author":"Briot","year":"2013","journal-title":"Bone"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1007\/s00774-013-0529-7","article-title":"Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: The Eastern European TBS study","volume":"32","author":"Vasic","year":"2014","journal-title":"J. Bone Miner. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s00198-012-2188-2","article-title":"Trabecular bone score improves fracture risk prediction in non-osteoporotic women: The OFELY study","volume":"24","author":"Boutroy","year":"2013","journal-title":"Osteoporos. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s00198-013-2502-7","article-title":"Added value of trabecular bone score over bone mineral density for identification of vertebral fractures in patients with areal bone mineral density in the non-osteoporotic range","volume":"25","author":"Nassar","year":"2014","journal-title":"Osteoporos. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s00223-009-9322-y","article-title":"A retrospective case-control study assessing the role of trabecular bone score in postmenopausal Caucasian women with osteopenia: Analyzing the odds of vertebral fracture","volume":"86","author":"Winzenrieth","year":"2010","journal-title":"Calcif. Tissue Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s00223-015-9952-1","article-title":"Fracture discrimination by combined bone mineral density (BMD) and microarchitectural texture analysis","volume":"96","author":"Touvier","year":"2015","journal-title":"Calcif. Tissue Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.bone.2009.06.032","article-title":"A multicentre, retrospective case-control study assessing the role of trabecular bone score (TBS) in menopausal Caucasian women with low areal bone mineral density (BMDa): Analysing the odds of vertebral fracture","volume":"46","author":"Rabier","year":"2010","journal-title":"Bone"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5455\/medarh.2018.72.46-50","article-title":"The Trabecular Bone Score Predicts Spine Fragility Fractures in Postmenopausal Caucasian Women Without Osteoporosis Independently of Bone Mineral Density","volume":"72","author":"Ripamonti","year":"2018","journal-title":"Med. Arch."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1172\/JCI113523","article-title":"Age and bone mass as predictors of fracture in a prospective study","volume":"81","author":"Hui","year":"1988","journal-title":"J. Clin. Investig."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e3999","DOI":"10.1136\/bmj.e3999","article-title":"Interpreting diagnostic accuracy studies for patient care","volume":"345","author":"Mallett","year":"2012","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101","DOI":"10.11005\/jbm.2021.28.2.101","article-title":"Application of the Trabecular Bone Score in Clinical Practice","volume":"28","author":"Kong","year":"2021","journal-title":"J. Bone Metab."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_19","first-page":"203","article-title":"Measures of Diagnostic Accuracy: Basic Definitions","volume":"19","year":"2009","journal-title":"Ejifcc"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1093\/biomet\/26.4.404","article-title":"The Use of Confidence or Fiducial Limits Illustrated in the Case of the Binomial","volume":"26","author":"Clopper","year":"1934","journal-title":"Biometrika"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4179","DOI":"10.1002\/sim.2850","article-title":"Comparison of the likelihood ratios of two binary diagnostic tests in paired designs","volume":"26","author":"Nofuentes","year":"2007","journal-title":"Stat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1002\/sim.2677","article-title":"Confidence intervals for predictive values with an emphasis to case-control studies","volume":"26","author":"Mercaldo","year":"2007","journal-title":"Stat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1002\/sim.5587","article-title":"A weighted generalized score statistic for comparison of predictive values of diagnostic tests","volume":"32","author":"Kosinski","year":"2013","journal-title":"Stat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S0895-4356(03)00009-X","article-title":"Improving screening accuracy for dementia in a community sample by augmenting cognitive testing with informant report","volume":"56","author":"Mackinnon","year":"2003","journal-title":"J. Clin. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/j.bone.2006.11.017","article-title":"Discriminative ability of dual-energy X-ray absorptiometry site selection in identifying patients with osteoporotic fractures","volume":"40","author":"Arabi","year":"2007","journal-title":"Bone"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/j.1651-2227.2006.00180.x","article-title":"Understanding diagnostic tests 1: Sensitivity, specificity and predictive values","volume":"96","author":"Akobeng","year":"2007","journal-title":"Acta Paediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jocd.2013.05.001","article-title":"Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women","volume":"17","author":"Krueger","year":"2014","journal-title":"J. Clin. Densitom."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e100453","DOI":"10.1136\/gpsych-2020-100453","article-title":"Relations among sensitivity, specificity and predictive values of medical tests based on biomarkers","volume":"34","author":"Wang","year":"2021","journal-title":"Gen. Psychiatr."},{"key":"ref_29","first-page":"54","article-title":"Updated incidence rates of fragility fractures in Italy: Extension study 2002\u20132008","volume":"8","author":"Piscitelli","year":"2011","journal-title":"Clin. Cases Miner. Bone Metab."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14315\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:09:09Z","timestamp":1760144949000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14315"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,2]]},"references-count":29,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192114315"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192114315","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,2]]}}}