Added value of trabecular bone score to bone mineral density for prediction of osteoporotic fractures in postmenopausal women: The OPUS study

Karine Briot*, Simon Paternotte, Sami Kolta, Richard Eastell, David M. Reid, Dieter Felsenberg, Claus C. Glüer, Christian Roux

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

107 Citations (Scopus)


The objective of this study was to consider whether trabecular bone score (TBS) improves on areal bone mineral density (aBMD) measurement alone for the prediction of incident fractures in postmenopausal women. Patients and methods: The OPUS study was conducted in ambulatory European women aged above 55. years, recruited in 5 centers followed over 6. years. For the assessment of the performance of TBS, baseline Hologic scans from 3 centers (Kiel, Paris and Sheffield) were available. Follow-up for incident fractures was available for 1007 women (mean age 65.9. ±. 6.9. years). We compared the performance of TBS, aBMD, and their combination, by using net reclassification improvement (NRI, primary analysis) and receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under the curves (AUCs) (secondary analyses). Results: 82 (8.1%) subjects with incident clinical osteoporotic fractures, and 46 (4.6%) with incident radiographic vertebral fractures were recorded over 6. years. Performance of TBS was significantly better than lumbar spine (LS) aBMD for the prediction of incident clinical osteoporotic fractures (NRI. =. 16.3%, p. =. 0.007). For radiographic vertebral fractures, TBS and LS aBMD had similar predictive power but the combination of TBS and LS aBMD increased the performance over LS aBMD alone (NRI. =. 8.6%, p. =. 0.046) but the prediction is similar to hip and femoral neck aBMD. In non osteoporotic women, TBS predicted incident fragility fractures similarly to LS aBMD. Conclusions: This prospective study shows that in general population, TBS is a useful tool to improve the performance of lumbar spine aBMD for vertebral osteoporotic fractures.

Original languageEnglish
Pages (from-to)232-236
Number of pages5
Issue number1
Publication statusPublished - 1 Nov 2013

Bibliographical note

We would like to acknowledge the contributions of the other members of the OPUS teams at the five participating centers: Rosie Reid (deceased), Lana Gibson and Alison Stewart in Aberdeen; Antonia Gerwinn, Dr. Maren Glüer, Roswitha John, Roswitha Marunde-Ott, Monika Mohr, Regina Schlenger, Pia Zschoche, Dr Reinhard Barkmann, Dr. Carsten Liess, Carsten Rose and Wolfram Timm in Kiel; Therese Kolta, Nathalie Delfau in Paris; and Margaret Paggiosi, Nicky Peel, Diane Shutt, Anne Stapleton and Debbie Swindell in Sheffield. This project would not have been possible without the financial support of our sponsors: Aventis, Eli Lilly, Novartis, Procter & Gamble Pharmaceuticals, and Roche. We also would like to thank for the support of the equipment manufacturers: DMS, IGEA, OSI/Osteometer Meditech, Quidel/metra.

Authors have no conflict of interest to declare.


  • Bone densitometry
  • Fracture
  • Osteoporosis
  • TBS
  • Vertebral fracture


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