Densitometer-Specific Differences in the Correlation Between Body Mass Index and Lumbar Spine Trabecular Bone Score

The CaMos Research Group

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40 Scopus citations


Trabecular bone score (TBS) is a gray-level texture measure derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images that predicts fractures independent of bone mineral density (BMD). Increased abdominal soft tissue in individuals with elevated body mass index (BMI) absorbs more X-rays during image acquisition for BMD measurement and must be accommodated by the TBS algorithm. We aimed to determine if the relationship between BMI and TBS varied between 2 major manufacturers’ densitometers, because different densitometers accommodate soft tissues differently. We identified 1919 women and 811 men, participants of the Canadian Multicentre Osteoporosis Study, aged ≥40 yr with lumbar spine DXA scans acquired on GE Lunar (4 centers) or Hologic (3 centers) densitometers at year 10 of follow-up. TBS was calculated for L1–L4 (TBS iNsight® software, version 2.1). A significant negative correlation between TBS and BMI was observed when TBS measurements were performed on Hologic densitometers in men (Pearson r = −0.36, p < 0.0001) and in women (Pearson r = −0.33, p < 0.0001); significant correlations were not seen when TBS was measured on GE Lunar densitometers (Pearson r = 0.00 in men, Pearson r = −0.02 in women). Age-adjusted linear regression models confirmed significant interactions between BMI and densitometer manufacturer for both men and women (p < 0.0001). In contrast, comparable positive correlations were observed between BMD and BMI on both Hologic and GE Lunar densitometers in men and women. In conclusion, BMI significantly affects TBS values in men and women when measured on Hologic but not GE Lunar densitometers. This finding has implications for clinical and research applications of TBS, especially when TBS is measured sequentially on DXA densitometers from different manufacturers or when results from different machines are pooled for analysis.

Original languageEnglish (US)
Pages (from-to)233-238
Number of pages6
JournalJournal of Clinical Densitometry
Issue number2
StatePublished - Apr 2017

Bibliographical note

Funding Information:
The Canadian Multicentre Osteoporosis Study is currently funded by the Canadian Institutes of Health Research (CIHR, MOP 111103), Amgen, and Eli Lilly Canada. These funding sources had no role in the conception of this analysis, statistical methods, or interpretation of the data. SN Morin is a research scholar of the Fonds de Recherche du Québec en Santé.

Publisher Copyright:
© 2016


  • Body mass index
  • bone mineral density
  • cohort study
  • densitometer
  • trabecular bone score


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